Orthopedic Coding Alert

Don't shortchange your -return to the OR- fee When complications from an initial procedure cause your orthopedic surgeon to perform a follow-up procedure for a Medicare patient, you may be able to report the follow-up separately. How? If the follow-up procedure was serious enough that the orthopedic surgeon had to perform it in an operating room (OR) or suite (hospital or ambulatory surgical center), you may be able to get paid (partially) for it by using modifier 78 (Unplanned return to the operating/procedure room by the same physician following initial procedure for a related procedure during the postoperative period). Stay alert: This modifier's descriptor got an update for 2008. CPT added "unplanned" to distinguish it from modifier 58 (Staged or related procedure or service by the same physician during the postoperative period), which indicates some planning or anticipation. CPT also clarified that you should use modifier 78 for a return to the operating room or procedure room to avoid "limiting this code to inpatient procedures only," according to the AMA's CPT Changes: 2008. Take note: To use modifier 78 correctly, you must be sure your orthopedic surgeon performed the second procedure at the proper place of service. You need to know which types of services are part of your payer's global package and which ones aren-t, or you might over-report on a claim. You also need to know the global period for the initial procedure. Things Getting Complicated? Think 78 If your orthopedic surgeon treats a patient during an earlier procedure's global period, keep your eyes peeled for modifier 78 possibilities. If a subsequent procedure is related to the first procedure and requires a return to the operating or procedure room, modifier 78 may be appropriate. Example: A patient had a severe hip joint infection after total hip arthroplasty (27130, Arthroplasty, acetabular and proximal femoral prosthetic replacement [total hip arthroplasty], with or without autograft or allograft). The surgeon returned the patient to the operating room for hip arthrotomy during the arthroplasty's global period. You should append modifier 78 to the arthrotomy code, 27030 (Arthrotomy, hip, with drainage [e.g., infection]). ICD-9 tip: Don't ignore your diagnosis coding. The reason for the return to the operating room is not the same as the reason for the original surgery. For infection, for instance, you should link an appropriate diagnosis, such as 996.66 (Infection and inflammatory reaction due to internal prosthetic device, implant and graft; due to internal joint prosthesis), to the procedural code and follow the ICD-9 instruction to report an additional code to identify the infected prosthetic joint (V43.60-V43.69). And remember that the global period stays with the original case, says Lisa Rickert with Doctor's Billing Inc. in Hanover, Mass. Payers will [...]