Orthopedic Coding Alert

Question: During the global period for 99024 (postoperative follow-up visit, included in global service) injections are not being paid by Medicare. Is there a proper modifier to use for reimbursement?

Laurie Garza
Galveston, Texas

Answer: There are two possible scenarios to consider:

1. A patient has a total hip arthroplasty and on the 40th postoperative day receives an injection of
Celestone for osteoarthritis of the knee. Obviously,
the injection of the knee (20610, arthrocentesis,
aspiration and/or injection; major joint or bursa
[e.g., shoulder, hip, knee joint, subacromial bursa])
is not related to the total hip arthroplasty, and it
should be paid separately. In this case, the modifier
you need is -79 (unrelated procedure or service by the same physician during the postoperative period). Modifier -79 would be appended to 20610.

2. A patient has an arthroscopic meniscectomy of the
knee, and on the 10th postoperative day the surgeon
has to aspirate the knee (20610) because a large effusion has developed. The aspiration is performed in the surgeons office. Unfortunately, if this is a Medicare patient, the aspiration will not be paid separately. According to Medicares global surgery policy, the approved amount for surgical procedures includes payment for all additional
medical and surgical services required of the surgeon during the postoperative period that do not require a return trip to the operating room. In this case, because the aspiration of the knee is related to the original surgery, no additional benefits will be allowed for 20610.