Urology Coding Alert

Question: A patient is in the postoperative period following a simple prostatectomy. He returns to our surgeon for an in-hospital operating room repair of an extensive complicated fascial dehiscence. What procedure code should I report? Can I bill for the procedure performed in the global period? Do I need a modifier to get paid?

Maryland Subscriber

Answer: This patient’s problem is a complication of his prostatic surgery and has occurred within the postoperative 90 day global of the surgery. The procedure to correct the complication, when performed in the hospital OR, becomes a billable service for both Medicare and most non-Medicare insurance carriers. A modifier will be necessary to receive reimbursement within a global period.

To receive payment for this corrective surgery performed in the operating room within the global, report procedure code 13160 (Secondary closure of surgical wound or dehiscence, extensive or complicated) for the repair of the dehiscence and add 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 procedure) to  insure payment of this service in the global period of the prostatic surgery. No modifier is needed if the repair occurs after the 90 day global period.