Gastroenterology Coding Alert

Learn what percentage of reimbursement you can expect When complications from an initial procedure cause a gastroenterologist to perform a follow-up procedure, you may be able to separately report the follow-up. How? If the follow-up procedure was serious enough that the gastroenterologist had to perform it in an operating room (OR) or endoscopic suite (hospital or ASC), you may be able to get paid (partially) for it by using modifier 78 (Return to the operating room for a related procedure during the postoperative period), says Maggie M. Mac, CMM, CPC, CMSCS, CCP, ICCE, consulting manager for Pershing, Yoakley & Associates in Clearwater, Fla. Stay alert: On Jan. 1, this modifier's definition changes to "Unplanned return to the operating/procedure room by the same physician following initial procedure for a related procedure during the postoperative period." This CPT 2008 revision clarifies its use. Take note: To use modifier 78 correctly in 2007 or 2008, you must be sure your gastroenterologist performed the second procedure at the proper place of service. You need to know which types of services are part of the global package and which ones aren't or you might over-report on a claim. You also need to know the global period for the initial procedure. For instance, surgical procedures like hemorrhoid treatments can have global periods of 10 to as long as 90 days. However, all endoscopy procedures have a global period of one day, ending at midnight on the day of the procedure. Things Getting Complicated? Think 78 If your gastroenterologist treats a patient during the global period of an earlier procedure, keep your eyes peeled for modifier 78 possibilities, says Cindy Parman, CPC, CPC-H, RCC, co-founder of Coding Strategies Inc. in Powder Springs, Ga. "When a subsequent procedure is related to the first procedure and requires the use of an operating room, you may report the related procedure with modifier 78," Parman says.- Example: A patient has hemorrhoids, and the gastroenterologist cauterizes three internal hemorrhoids with a heater probe. The next day, the patient calls complaining of severe rectal pain. The gastroenterologist returns the patient to the operating room for a flexible sigmoidoscopy and discovers the patient has bleeding in the hemorrhoid-removal area. The gastroenterologist then uses a heater probe to stop the bleeding. In this case, a patient was returned to the OR for a subsequent procedure directly related to the hemorrhoid removal during the global period. On the claim, you should: • report 46934 (Destruction of hemorrhoids, any-method; internal) for the hemorrhoid removal) • attach 455.2 (Internal hemorrhoids with other complication) to 46934 • report 45334 (Sigmoidoscopy, flexible; with control-of bleeding [e.g., injection, bipolar cautery, unipolar-cautery, laser, heater probe, stapler, plasma-coagulator]) for the sigmoidoscopy • attach [...]