General Surgery Coding Alert

 Question: The surgeon sees a patient in the office after creating an arteriovenous (AV) fistula. The patient has a small abscess at the site, so the surgeon opens the patient and removes an infected portion of the graft. Can we bill for the office procedure using modifier -78 or -79?
          
Alabama Subscriber
 
Answer: The creation of the AV fistula 36825 (Creation of arteriovenous fistula by other than direct arteriovenous anastomosis [separate procedure]; autogenous graft) or 36830 (... nonautogenous graft) has a 90-day global period, which means that any related procedure or service that does not require a return to the operating room is included in the fistula creations surgical package and should not be billed.
 
Because the second procedure was performed in the surgeons office, modifier -78 (Return to the operating room for a related procedure during the postoperative period) should not be appended to Medicare carriers.
 
Furthermore, because the abscess is an infection on the AV fistula graft that was created, it is considered related, which means modifier -79 (Unrelated procedure or service by the same physician during the postoperative period) should not be billed to Medicare carriers. Some private carriers may pay for the service, however, with modifier -78 appended.