Podiatry Coding & Billing Alert

Question: The podiatrist performed surgery on a patient at the ASC for an elongated second metatarsal. The surgery consisted of an oblique distal osteotomy with single screw fixation. The podiatrist then saw the patient at weekly intervals with no complications after two weeks. The podiatrist took an X-ray at the third visit, and he noticed that the osteotomy was displaced and the screw had pulled out. The podiatrist talked to the patient and learned that he slipped on a step two nights ago. The podiatrist took the patient back to the operating room at the ASC, removed the screw, realigned the osteotomy, fixated the bone, and immobilized the patient in a BK cast. What code should we report?

Maine Subscriber

Answer: You should report 28322 (Repair, nonunion or malunion; metatarsal, with or without bone graft [includes obtaining graft]) -LT-78 for this service.

In this case, you would append 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) to 28322 because it was unplanned and not part of the normal healing process.

Note: The patient's original surgery for an elongated second metatarsal, which consists of an oblique distal osteotomy with single screw fixation, has a 90-day global period.

Caution: If the podiatrist performs an unplanned procedure, you should consider the procedure only billable if you perform the procedure in an operating room and use modifier 78. Do not bill procedures related to the problem for which the patient is in a global period (even a debridement of this post-op infection site) if the procedure occurs in the office.