# PEG Tube pulled out by patient



## penswhitex (Apr 19, 2016)

Good morning all,

I need an opinion on the following situation.  The physician placed a G-tube in an open fashion two weeks ago (90 day global).  The patient who has end-stage Parkinson's disease as well as mental retardation, pulled the tube out and caused a gastric tear.  So, the surgeon has to see the patient again and repair this tear.  I don't see this as a complication of the procedure as the patient caused this.  So, am I thinking too hard or should this be billed with a -78 or -79 modifier for the return to the OR? And, what about the visit to make the decision to take the patient to surgery?  Should this be billed as well?  Thank you.


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## krssy70 (Jun 10, 2016)

I dont think it should matter how the tear happened. The physician should still get credit for the work he did regarding of why or how it happened. I would bill the repair of the tear with a modifier 78. As for the office visit during the global period, I wouldn't bill that. It is still part of the global period even though he decided to take the pt back to surgery.


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## cgaston (Jun 10, 2016)

https://www.cms.gov/Outreach-and-Ed...oducts/downloads/GloballSurgery-ICN907166.pdf


Per the attached "treatment for post-operative complications requiring a return trip to the Operating Room are not included in the global surgical package". Modifier -79 is appropriate for the surgery.

I also am not sure if I would bill the E&M. I am thinking it would be OK to bill an established patient visit with modifiers -24 and -57 if you use some kind of "complication of" ICD 10 code since the complications are not included in the post-op period; but then again, only returns to the O/R are stated as not included - not the E&M codes.


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