Otolaryngology Coding Alert

Question: Yesterday, a patient had 30520 and 30140-50. Later that same day, the patient returned to the OR for 31238. Should I use modifier 78 on 31238?

Texas Subscriber

Answer: No. You should not use modifier 78 (Unplanned return to the procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period).

Because the bleed control (31238, Nasal/sinus endoscopy, surgical; with control of nasal hemorrhage) occurs on the same day as the septoplasty (30520, Septoplasty or submucous resection, with or without cartilage scoring, contouring or replacement with graft) and bilateral turbinate resection (30140-50, Submucous resection inferior turbinate, partial or complete, any method; Bilateral procedure), append 31238 with modifier 59 (Distinct procedural service).

Rationale: Modifier 59 indicates the otolaryngologist performed 31238 at a different operative session. Since control of bleeding is incident-to any surgery, modifier 59 shows that the control of the hemorrhage took place during a different operative session. If the epistaxis control was on a different day than the nasal surgeries, different modifiers would come into play. Choose the appropriate modifier based on the nasal hemorrhage control’s relation to the nasal surgery.

When modifier 78 works: If the bleed was from the operative site and the control of it required the physician to take the patient back to the OR, you can append modifier 78 to 31238.

When modifier 79 works: When the hemorrhage is unrelated to the nasal surgery, append modifier 79 (Unrelated procedure or service by the same physician during the postoperative period) to 31238. Had the physician controlled the hemorrhage bedside, in the emergency room, or in the office, and the patient was not a Medicare patient, you would use modifier 79 with 31238. You would include modifier 79 even if it was a complication of the surgery since the AMA states that complications of surgeries are separately billable outside of the global period.

Medicare, on the other hand, will only pay for complications, which require a return to the OR and justify a modifier 78.