Neurosurgery Coding Alert

Question:
A patient who underwent a skull fracture reduction returns to our surgeon after one week. The patient is taken in for an in-hospital operating room repair of an extensive complicated wound dehiscence. How can we report this repair? Can we bill for the procedure performed in the global period? Do we need to append a modifier for these services?

Maryland Subscriber

Answer: From the description provided, the patient’s problem of dehiscence follows an earlier surgery for skull fracture reduction and has occurred within the postoperative 90 day global of the surgery. The procedure to correct the complication, when performed in the hospital OR, becomes a billable service for both Medicare and most non-Medicare insurance carriers. To receive payment for this corrective surgery performed in the operating room within the global, you may report procedure code 13160 (Secondary closure of surgical wound or dehiscence, extensive or complicated) for the repair of the dehiscence

Modifier: A modifier will be necessary to receive reimbursement within a global period. You 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 procedure) to ensure payment of this service in the global period of the skull fracture surgery.

90 day global period: No modifier is needed if the repair occurs after the 90 day global period.