Orthopedic Coding Alert

Question: Our surgeon performed a total knee replacement on a Medicare patient on Sept. 19. On Oct. 14, the surgeon re-admitted the patient to the hospital for a postoperative infection. Can I bill an admission with a diagnosis of 998.59 for the second admission? The surgeon debrided the wound many times while the patient was in the hospital and also did a revision. Should I append modifier 78 or 79 (Unrelated procedure or service by the same physician during the postoperative period) on the debridements and the revision?


South Carolina Subscriber

Answer: Unfortunately, you cannot separately report the admission to Medicare, and no modifier will change that. Medicare payers will bundle the subsequent admission into the global surgical package.

You can, however, report the surgeon's work  debriding the wounds because the surgeon most likely returned the patient to the operating room for the services. You will most likely report 27301-78 (Incision and drainage, deep abscess, bursa, or hematoma, thigh or knee region; Return to the operating room for a related procedure during the postoperative period) for the debridements.

Ask your surgeon which code best applies to the revision--for example, you might report 27447-78 (Arthroplasty, knee, condyle and plateau; medial AND lateral compartments with or without patella resurfacing [total knee arthroplasty]) for the service if he performed another knee replacement.