Ob-Gyn Coding Alert

If an ob-gyn patient has to return to the operating room for additional treatment during the global period, you can receive additional reimbursement, as long as you append modifier -78 or -79 to the procedure code. The key is determining whether the secondary procedure is related to the original procedure. Differentiate Between -78 and -79 Many coders believe that modifiers -78 (Return to the operating room for a related procedure during the postoperative period) and -79 (Unrelated procedure or service by the same physician during the postoperative period) are interchangeable, but there are distinct differences between the two that go beyond the fact that modifier -78 refers to a related procedure and -79 refers to an unrelated service. Specifically, modifier -78 does not launch a new postoperative global period, and therefore, any service with modifier -78 appended exists within the original global period.

If you append modifier -79 to a service, however, Section 4822 of the Medicare Carriers Manual (MCM) states, "A new postoperative period begins when the unrelated procedure is billed."

For instance, the ob-gyn performs a total abdominal hysterectomy (58200), and the patient returns 65 days later for a partial vulvectomy (56620).

"In this example, the vulvectomy performed in the post-op period is not a re-operation or treatment for a surgical complication," says Mary Mulholland, RN, BSN, CPC, a reimbursement analyst for the office of clinical documentation at the University of Pennsylvania's department of medicine in Philadelphia. "Both surgical procedures are clearly unrelated to one another. To report these distinct procedures accurately and to receive appropriate reimbursement, you should append modifier -79 to 56620."

Although the patient only had 25 days left in the original global period, using modifier -79 on the claim will launch a new global period for an additional 90 days. What Makes a Service 'Related'? Suppose an ob-gyn performs a total abdominal hysterectomy (58150) on a patient with a history of poorly controlled diabetes and peripheral vascular disease. The surgical site dehisces postoperatively and begins to bleed. The physician must go back to the operating room (OR) to reclose the wound (49900), Mulholland says. The first surgery should be coded as 58150, and report the second surgery as 49900-78. Remember that you should append modifiers -78 and -79 to the related or unrelated procedure and not to the original surgery. If a secondary procedure is required because the patient had the first procedure, then the two services are related. "You should note that documentation that supports the use of this modifier may be requested by your carrier before payment," says Jean Ryan-Niemackl, LPN, CPC, compliance analyst for QuadraMed, a multispecialty coding consulting firm in Fargo, N.D. Modifier -78 Requires Return to OR Because modifier [...]