Reader Question:
Modifier -78 Key for Return to OR
Published on Fri Apr 30, 2004
Question: Six hours after our patient underwent a total vaginal hysterectomy and bilateral salpingo-oophorectomy, the ob-gyn returned her to the operating room for examination under anesthesia, diagnostic laparoscopy, evacuation of hemoperitoneum, and resuturing of pedicles, followed by exploratory laparotomy and religation of the right ovarian pedicles. How should I report these procedures?
Arizona Subscriber Answer: You should code for the diagnostic laparoscopy with 49320 (Laparoscopy, abdomen, peritoneum, and omentum, diagnostic, with or without collection of specimen[s] by brushing or washing [separate procedure]). You should also report 37617 (Ligation, major artery [e.g., post-traumatic, rupture]; abdomen) for resuturing the pedicles. You should not submit a code for evacuating the hemoperitoneum because that is considered part of preparing the operative field.
When reporting these procedures to the carrier, be sure to append the codes with modifier -78 (Return to the operating room for a related procedure during the postoperative period). In addition, you should link these codes to 998.11 (Hemorrhage complicating a procedure) and V64.41 (Laparoscopic surgical procedure converted to open procedure).
