Radiology Coding Alert

How to collect for services you perform during the global period If your interventional radiologist performs additional procedures during a patient's global period, you can collect extra reimbursement if you append modifiers -58,  -78 or -79 to the procedure code. But first you must determine whether the patient returns to the operating room, and whether the secondary procedure is related to the original surgery.

The following five tips can help your practice decide which modifier best fits your claim. Tip 1: Append Modifier -58 for Related or Anticipated Procedures Modifier -58 (Staged or related procedure or service by the same physician during the postoperative period) applies if your postoperative service meets one of the following criteria:

When the physician performs the first procedure, he determines that he will have to perform an additional procedure during the global period.
The second procedure is more extensive than the original procedure.
The patient must return for therapy following a diagnostic surgical procedure.   Rationale: In each case, the subsequent procedure is either related to the underlying problem or diagnosis that prompted the initial surgery, anticipated when the surgeon performs the first procedure, or both, says Sharon Tucker, CPC, president of Seminars Plus, a Fountain Valley, Calif., consulting firm specializing in coding, documentation and compliance issues.

In other words, the patient's condition, rather than prior surgical results, dictates the need for additional procedures, Tucker says. You should not append modifier  -58 if the patient requires a follow-up procedure due to surgical complications or unexpected postoperative findings that arise from the initial surgery.

Example: The interventional radiologist places a percutaneous transhepatic catheter for biliary drainage. Due to the patient's infection, the physician cannot place a necessary stent, so he plans to perform stent placement four days after the catheter placement.

Because 47510 (Introduction of percutaneous transhepatic catheter for biliary drainage) carries a 90-day global period, the patient's carrier will deny the stent placement four days postsurgery, unless the practice appends modifier -58 to the stent insertion code.

The interventionalist should report CPT 47510 for the first procedure and 47511-58 (Introduction of percutaneous transhepatic stent for internal and external biliary drainage) after he inserts the stent. And, the operative report should reflect the reason for the staged procedure, such as biliary sepsis. Tip 2: If It's a Complication, Turn to -78 Unlike modifier -58, you should append modifier -78 (Return to the operating room for a related procedure during the postoperative period) when reasons related to the original surgery (such as postoperative complications) cause the radiologist to perform a related procedure.

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