Podiatry Coding & Billing Alert

Question: A patient had surgery for an elongated second metatarsal at the ASC. The surgery consisted of an oblique distal osteotomy with single screw fixation. This has a 90-day global period. The patient was seen at weekly intervals with no complication after two weeks. At the third visit, an x-ray is taken, and the podiatrist noticed that the osteotomy was displaced and the screw had pulled out. When questioned, the patient stated that he slipped on a step two nights ago. The podiatrist decided to take the patient back to the operating room at the ASC to remove the screw, realign the osteotomy, fixate the bone, and immobilize the patient in a BK cast. Which code should we report for that second trip to the OR?

California Subscriber

Answer: You would report 28322 (Repair, nonunion or malunion; metatarsal, with or without bone graft (includes obtaining graft)). Notice that you should 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 this code.

Proper use of modifier 78: 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.

You should also append either the LT (Left side) or RT (Right side) modifier, depending upon what side of the body the podiatrist performed the surgery on.