Otolaryngology Coding Alert

Question: Measure #20 (Perioperative care: timing of antibiotic prophylaxis -quot; ordering physician) says that the physician must provide the antibiotic within one hour of the start of surgery. If the otolaryngologist provides an antibiotic later on, should I simply not report this code?

Virginia Subscriber

Answer: This measure applies when the physician gives only the order for an antibiotic within the one- to two-hour (for vancomycin) window before the incision is made. So if the patient doesn't receive the antibiotic during that timeframe, but your otolaryngologist documented the order (written, verbal or standing order/protocol), you should report the measure (4047F, Documentation of order for prophylactic antiobiotics to be given within one hour [if fluoroquinolone or vancomycin, two hours] prior to surgical incision [or start of procedure when no incision is required]). If documentation shows that the patient did not receive antibiotics due to a medical reason, such as a contraindication, append 4047F with modifier 1P (Performance exclusion modifier due to medical reasons) to explain why the staff didn't administer the antibiotic within the required timeframe.

When staff give the antibiotic within an hour prior to surgery, you should instead use measure 4048F (Documentation that prophylactic antibiotic was given within one hour [if fluoroquinolone or vancomycin, two hours] prior to surgical incision [or start of procedure when no incision is required]). You do not report both the order for and the administration of the antibiotic.