General Surgery Coding Alert

Find out if youre a modifier coding pro by checking your answers to the five quiz questions on page 60 against this answer key.

Answer 1: A. For Medicare payers, you should append modifier 58 (Staged or related procedure or service by the same physician during the postoperative period) to the open procedure to indicate that the diagnostic endoscopy and the open surgical service are staged or planned.

Pitfall: While modifier 59 (Distinct procedural service) may seem appropriate, the Correct Coding Initiative (CCI) specifically states that if there is another appropriate modifier -- in this case, 58 -- you should use that modifier instead of 59. Some payers may still want you to use 59, along with 58, so check with your individual payer.

Answer 2: B. If the surgeon converts to an open surgery during a laparoscopic procedure, you should only report the open procedure, according to CPT and CMS guidelines. You should not report the laparoscopic procedure with a modifier, such as 53 (Discontinued procedure), in addition to the open code.

Bonus: If your surgeon must spend extra time and effort on the procedure because he converted from lap to open, you may be justified in appending modifier 22 (Increased procedural services) to the open procedure code. Youll need to back up your coding with solid documentation describing in detail the services extensive nature -- for instance, by comparing it to a typical case.

Answer 3: B. You should view the final treatment as a staged or planned procedure. Allografts are temporary skin coverings and are not intended to be the final treatment for a burn. You should code the planned return for the autograft using modifier 58 (Staged or related procedure or service by the same physician during the postoperative period) since the procedure is in the global period of the previous allograft treatment.

Answer 4: B. When you file claims with modifier 78 (Unplanned return to the operating/procedure room by the same physician following initial procedure for a related procedure during the postoperative period), you shouldnt expect to receive the full fee schedule reimbursement.

Procedures billed with modifier 78 include only the intraoperative portion of the service (no payment is made for pre- and postoperative care). They are generally reimbursed at 65-80 percent of the full fee schedule value, depending on how the fee schedule allocates the presurgical, intraoperative, and postsurgical portions of the reimbursement for a particular CPT code.

Answer 5: D. You should append modifier 59 (Distinct procedural service) to the biopsy code to show that it occurred at a different location from the excision. Some payers will also require you to use modifiers RT (Right side) and LT (Left side) to accurately describe this scenario.

--  Answers provided or reviewed by Maggie Mac, CPC, CEMC, CHC, CMM, ICCE, manager at Pershing Yoakley & Associates, P.C. in Clearwater, Fla.