Orthopedic Coding Alert

Question: One of our patients fell and pulled the screws out of a plate our orthopedist placed two weeks prior at the proximal tibia with an ORIF. So he had to go back in and redo the procedure. Since we-re still within the global period, should I just use the same codes again and add modifier 78?

South Carolina Subscriber

Answer: You-re correct that you should report the same codes as for the initial procedures, and modifier 78 (Return to the operating room for a related procedure during the postoperative period) would be your best choice for the tibial open reduction internal fixation (ORIF). You should reserve modifier 78 for surgical complications that require your surgeon to return the patient to the OR, as in this case.

On the other hand, some payers may require you to use modifier 76 (Repeat procedure by same physician) because your coding for the second procedure is identical to that for the first, and this modifier alerts the payer that the second claim is not a duplicate of the first.

Your best bet is to contact your payer and determine which modifier you should use. And be sure to get the carrier's instructions in writing to protect yourself in case of an audit.

Although your CPT codes will remain the same, your diagnosis codes will definitely change. For the second ORIF, your primary diagnosis will be 996.40 (Unspecified mechanical complication of internal orthopedic device, implant, and graft), and your secondary diagnosis code should be E888.x (Other and unspecified fall).