Wiki Hip dislocation following hip arthroplasty

[mbort]

Modifier HELP!!

I need thoughts on this scenario please:

pt has total hip arthroplasty--is released from the hospital on Sat.

Pt returns to ER on Sunday for dislocation is seen by different surgeon within same practice (same tax id). Reduction is attempted in the ER (under conscious sedation) but was unsuccessful.

Patient was then admitted and closed reduction was performed in the OR under general on Monday.

I should add that the notes indicate that the patient "just simply sat up in bed this time and dislocated it some time today."

My confusion is not with the CPT's but the modifiers.

24 for the ER visit?
78/58? with the reduction and an additional 52/53 because it was unsuccessful???

any input is most appreciated!

 

[mbort]

Anybody have any thoughts on this....its still on my desk and I am still pondering

 

[kevbshields]

-24 unnecessary, as not the same provider group and not the same specialty.

-78 on the surg. service--this is a complication.

-53/52 not needed. The physician did not have any way of knowing the patient would subsequently dislocate; also, we do not code based on the clinical outcome of the service, but on whether that service was provided in part, in whole or at all.