Anesthesia Coding Alert

Question: A patient returned to the OR later in the day for post-op bleed following a small bowel resection with lysis of adhesions. The surgeon performed a splenectomy during the return to the OR. Medicare has denied claims for this type of situation in the past; I had to complete a phone review and use a 76 modifier. I have also seen that some coders recommend using a 59 modifier. Which modifier is correct?

Wisconsin Subscriber

Answer: The case you describe is a covered expense and should be reimbursed. Report modifier 59 (Distinct procedural service) with the diagnosis code for postoperative bleeding.

Since the patient had a splenectomy, however, you might have another issue to consider. If the spleen was damaged during the small bowel resection, there may be a possibility the second surgery is considered a "never" event. There is also the possibility, however, that the damage was unavoidable and not considered a "never" event. Damage to organs during surgery is not specifically listed as a "never" event and may be within the consent form as a potential surgical risk. It might be a good idea to check with the anesthesiologist, surgeon, or hospital.