Otolaryngology Coding Alert

Question: Our otolaryngologist drained a peritonsillar abscess on December 1, and had to drain it again on December 4. The code for this service (42700, Incision and drainage abscess; peritonsillar) has a 10-day global period, so how do we bill for the second instance of it?

Tennessee Subscriber

Answer: You’ll need to append a modifier to tell the payer why you reported the service again during the global period. However, determining which modifier applies will depend on the documentation.

If the physician drained the abscess a second time due to a complication, modifier 78 (Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period) is your most likely option. Keep in mind, however, that to use this modifier, you must return the patient to the operating room. If you don’t, then it is not applicable.

If the physician planned the second procedure or performed it do more extensive drainage, then modifier 58 (Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period) is your best bet. If you use this modifier, you are not required to return the patient to the OR, and can perform the procedure in your office.