General Surgery Coding Alert

Question: Our physician performed split-thickness skin graft with excision of large skin cancer on lower extremity on a Medicare outpatient. That afternoon, the patient came to our office with a hemorrhage. In the office, we removed the graft to evaluate a hematoma and sutured a small bleeding artery. How should I code this?

Delaware Subscriber

Answer: Both of the original procedures 1160x (excision, malignant lesion, trunk, arms or legs [5th digit depends on size of lesion before excision]) and 15100 (split graft, trunk, arms, legs, first 100 sq. cm. or less, or one percent of body area of infants and children [except 15050]) have global periods (1160x, 10 days; 15100, 90 days). According to Medicare guidelines, only services for complications that require a return trip to the operating room are separately payable, and should be appended with modifier -78 (return to the operating room for a related procedure during the postoperative period). Because the surgeon performed the followup services in the office, they are included in the global period of the original procedure and are not payable, says Kathleen Mueller, RN, CPC, CCS-P, an independent general surgery coding and reimbursement specialist in Lenzburg, Ill.