General Surgery Coding Alert

Here's your chance to apply the information you have learned about selecting modifiers -58, -78 and -79. Take this quiz to fine-tune your coding skills.
 
Scenario 1: A 45-year-old patient has surgery for an initial inguinal hernia (49505, Repair initial inguinal hernia, age 5 years or over; reducible). The patient fails to care for the surgical wound properly, and 10 days later (within the 90-day global period of the initial surgery) returns to the surgeon's office with serious, deep infection at the incision site. To treat the infection, the surgeon must return the patient to the operating room. Once there, she removes the patient's infected tissue and re-dresses the wound (13160, Secondary closure of surgical wound or dehiscence, extensive or complicated).
 
Which modifier - -58 (Staged or related procedure or service by the same physician during the postoperative period), -78 (Return to the operating room for a related procedure during the postoperative period) or -79 (Unrelated procedure or service by the same physician during the postoperative period) - should you append to 13160?
 
Answer: In this case, you should select modifier -78. The infection is a complication arising from the initial surgery, not a result of a condition that prompted the surgery. In other words, the surgical wound did not become infected as a result of the inguinal hernia but from the surgery itself. Remember that the surgeon must
return the patient to the operating room to append modifier -78.

Scenario 2: The surgeon performs an excisional biopsy (19120, Excision of cyst, fibroadenoma, or other benign or malignant tumor, aberrant breast tissue, duct lesion, nipple or areolar lesion [except 19140], open, male or female, one or more lesions) on a 52-year-old female patient. The biopsy returns positive. The surgeon confers with the patient and returns her to the operating room five days later for a modified radical mastectomy (19240, Mastectomy, modified radical, including axillary lymph nodes, with or without pectoralis minor muscle, but excluding pectoralis major muscle) to remove the malignant tissue.
 
Should you append -58, -78 or -79 to 19240?
 
Answer: This example calls for modifier -58. Although the surgeon decided to perform the mastectomy because of the biopsy results, the surgery is related to the patient's underlying condition rather than to the biopsy. In other words, the surgeon did not perform the mastectomy because of a complication of the biopsy, but because of the presence of a malignant tumor revealed by the biopsy. The mastectomy is therefore related to and "more extensive than" the biopsy, and modifier -58 is correct.

Scenario 3: A 60-year-old diabetic patient must have a partial colectomy (44140, Colectomy, partial; with anastomosis). The surgery progresses as planned, but during the postoperative period the patient's surgical wound heals very slowly, and he also develops some minor internal bleeding, which requires additional surgical attention.
 
Which modifier - -58, -78 or -79 - should you append to the additional procedure codes reported during the post-operative period?
 
Answer: Modifier -58 is once again the appropriate choice. In this case, there is no evidence that the slow healing or internal bleeding developed because of infection or other surgical complication. Therefore, you should not choose modifier -78.
 
Rather, the diabetes probably caused the slow healing and bleeding, which complicates the patient's care. Modifier -58 is appropriate, even though diabetes was not the reason for the initial procedure (the colectomy).

Scenario 4: The patient in the first scenario above undergoes the same hernia repair. Rather than developing an infected wound, he accidentally spills boiling water on himself three weeks after surgery while attempting to prepare a meal. The same surgeon treats the patient for second-degree burns (16025*, Dressings and/or debridement, initial or subsequent; without anesthesia, medium [e.g., whole face or whole extremity]).
 
Should you append -58, -78 or -79 to 16020?
 
Answer: Here, you should select modifier -79. The burn care is not related to the initial surgery, the condition that prompted the initial surgery, or any underlying condition that complicates the patient's recovery. The burn is a new and separate problem that arose during the previous surgery's global period.