Otolaryngology Coding Alert

Question: Dr. A performs 30140 and 30150. Ten days later the patient returns to the office for post-op bleed related to the procedures, and Dr. B performs 31238. Is the post-op bleed control considered part of the turbinate resection and partial rhinectomy's global period?

Because the patient did not have to return to the OR, modifier 78 is inappropriate. Is there another way to bill for the bleed control, or must I record the procedure as a PO visit?


Maryland Subscriber

Answer: The answer depends on the patient's insurer.

If the patient is covered by Medicare, the epistaxis control (31238, Nasal/sinus endoscopy, surgical; with control of nasal hemorrhage) is part of the nasal surgeries- global period. (The 2006 National Physician Fee Schedule Relative Value File assigns 90 global days for both 30140, Submucous resection inferior turbinate, partial or complete, any method; and 30150, Rhinectomy; partial.)

Medicare considers all care related to complications included in the global, unless the procedure requires a return to the OR.

Exception: When billing non-Medicare plans that follow the AMA definition of a surgical package that does not include complications, you can report 31238 with modifier 79 (Unrelated procedure or service by the same physician during the postoperative period).

Although the bleed is related to the postoperative period, no modifier exists for -related but not in the OR.- So your only choice is modifier 79 with a diagnosis of PO hemorrhage (998.11, Other complications of procedures, not elsewhere classified; hemorrhage complicating a procedure).