Orthopedic Coding Alert

Question: Our orthopedic surgeon performed an open reduction with internal fixation (ORIF) of the right hip with a dynamic hip screw and right medial femoral condyle fracture on May 10. The same physician then performed an ORIF of a Monteggia's fracture with plating of the ulna on June 25. When we entered this claim into our computer system, our software recommended that we append modifier 58 to the June 25 charge since we performed it during the first ORIF's global period. Is that accurate?


New Mexico Subscriber

Answer: Because the June 25 surgery to repair the Monteggia's fracture was in no way related to the procedures that the surgeon performed on May 10 to repair fractures of the right hip and right distal femur, modifier 58 (Staged or related procedure or service by the same physician during the postoperative period) is
not appropriate.

Instead, you should append modifier 79 (Unrelated procedure or service by the same physician during the postoperative period) to the codes that you report for the June 25 charges.

This modifier shows the payer that you performed a surgery during the global period but that it had nothing to do with the first surgery.