General Surgery Coding Alert
Distinguish Return to Surgery Modifiers
Question: Our surgeon created an AV access for a dialysis patient, but the patient returned during the global period for a revision due to clotting. How should we bill for declotting the shunt with a balloon catheter, and do we need to use a modifier?
Ohio Subscriber
Answer: The correct code for the procedure is 36861 (External cannula declotting [separate procedure]; with balloon catheter). Even though the procedure is in the global period, if the patient is returned to surgery, you can bill the CPT® code for the service.
You should append 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 period) to 36861.
Because the declotting is not a staged procedure (it was not planned), you should not use modifier 58 (Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period).
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