General Surgery Coding Alert

Question: Our surgeon performed skin grafts for a Medicare patient with extensive burns on Sept. 19. On Oct. 14, the surgeon re-admitted the patient to the hospital for a postoperative infection. Can I bill a second admission for the post-op infection? The surgeon debrided the wounds many times while the patient was in the hospital. Should I append modifier 78 or 79 on the debridements?


South Carolina Subscriber

Answer: Unfortunately, you cannot separately report the admission to Medicare, and no modifier will change that. Medicare payers will bundle the subsequent admission into the global surgical package.

You can, however, report the surgeon's work debriding the wounds because the surgeon most likely returned the patient to the operating room for the services. Depending on the depth and extent of the debridement, you could choose from a number of codes to describe the procedure, such as 11040-11044 (Debridement ...).

As an alternative, skin graft preparation codes 15000 (Surgical preparation or creation of recipient site by excision of open wounds, burn eschar, or scar [including subcutaneous tissues], or incisional release of scar contracture; first 100 sq cm or one percent of body area of infants and children) and/or +15001 (... each additional 100 sq cm or each additional one percent of body area of infants and children [list separately in addition to code for primary procedure]) can include debridement of previous skin grafts if the surgeon immediately places a new skin graft onto the site (in this case, you would also report the subsequent skin grafts).

In any case, you should append modifier 78 (Return to the operating room for a related procedure during the postoperative period) to the appropriate debridement (or site preparation) code(s) rather than modifier 79 (Unrelated procedure or service by the same physician during the postoperative period).

Note: Non-Medicare payers may not treat infections as -related- to the initial surgery, and therefore may allow you to report a separate admission. Before coding the separate admission, however, you should check with your payer for its specifics.