Gastroenterology Coding Alert

Question: A patient has hemorrhoids and my 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 uses a heater probe to stop the bleeding. How should I code for this encounter?

Oregon Subscriber

Answer: Since the patient returned to the operating room (OR) for a subsequent procedure directly related to the hemorrhoid removal during the global period, you will need to use modifier 78 (Unplanned return to the operating/procedure room by the same physician following initial procedure for a related procedure during the postoperative period). That modifier will tell your payer that the second procedure involved a return to the OR to treat complications during the global period of an earlier procedure (the hemorrhoid removal).

You'll report the following codes:

• 46930 (Destruction of hemorrhoids, any method;internal) for the hemorrhoid removal
• 455.2 (Internal hemorrhoids with other complication) attached to 46934
• 45334 (Sigmoidoscopy, flexible; with control of  bleeding [e.g., injection, bipolar cautery, unipolar cautery, laser, heater probe, stapler, plasma coagulator]) for the sigmoidoscopy
• 998.11 (Hemorrhage complicating a procedure) attached to 45334
• modifier 78 appended to 45334 .

Remember: You'll use modifier 78 only for complications of the initial surgery that require a return to the OR. If your gastroenterologist can handle the complication without heading to the OR, you'll have to count the service as part of the initial surgery's global period.