General Surgery Coding Alert

Question: Our surgeon performed a partial colectomy with anastomosis. Six days later, the patient returns to the surgeon, who must return the patient to surgery to treat an extensive, complicated fascial dehiscence. How should I report this case? Can I bill for the second procedure since it occurred during the global period?

Codify Subscriber

Answer: For the initial procedure, you should report 44140 (Colectomy, partial; with anastomosis). For the return to surgery to repair the fascial dehiscence, report 13160 (Secondary closure of surgical wound or dehiscence, extensive or complicated) with modifier 78 (Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative procedure).

Here’s why: Although you shouldn’t separately bill for routine patient encounters concerning the colectomy surgery during the 90 day global period for code 44140, that’s not true if the surgeon must return the patient to the operating room to treat a complication of the initial surgery. Treating a complication during the global period is a billable service to Medicare and most other payers, and most payers require the 78 modifier before they’ll pay the claim.