Primary Care Coding Alert
Append Apt Modifier For Repeat Procedures During Global Period
Question: In the last issue of the “Family Practice Coding Alert,” there was a question about performing a repeat I&D procedure after the global period. My question is if the same I& D procedure was repeated within the global period, can it be reported again or will it get included in the global package?
New York Subscriber
Answer: You will report 10060 (Incision and drainage of abscess [e.g., carbuncle, suppurative hidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle, or paronychia]; simple or single) when your clinician performed the incision and drainage (I&D) procedure the first time. The CPT® code 10060 carries a 10-day global period. Per CPT®, the surgical package includes “typical postoperative follow-up care.”So, any follow-up procedures that are typically performed during that period will normally be included and will not be paid for separately.
However, if your clinician totally repeated the procedure, which is not typical, you can report the repeat procedure with another unit of 10060. To allow for payment of the second procedure, you will have to append the modifier 76 (Repeat procedure or service by the same physician or other qualified health care professional) to the second unit of the code that you are reporting. This will not only allow you to get 100% reimbursement for the repeat procedure, it will also restart the global period for the procedure. Modifier 76 is not restricted to procedures performed on the same day.
Alternatively, depending on the circumstances, you could use modifier 58 (Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period). Per CPT®, this modifier is used “to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure.”
In any case, you will likely need to append some kind of modifier to the second instance of 10060 done in the global period of the first instance to help ensure separate payment of the second procedure.
Primary Care Coding Alert
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