SavCoder
Contributor
Patient had Total Knee Arthroplasty (27447) performed on 6/4/19.
Patient developed infection and wound dehiscence. Patient returned to OR on 7/26/19 for partial revision of Total Knee Arthroplasty (27486) and wound dehiscence closure (13160). Modifier 78 added due to being a complication.
Patient developed another wound dehiscence. Patient returned to OR on 8/23/19 for wound dehiscence closure (13160). A culture was taken to determine if patient had infection and provider notated that if patient did have infection that patient would be brought back to OR for planned prosthesis removal with antibiotic spacers placed. Modifier 78 added to 13160 due to being a complication.
Culture came back with infection present. Patient brought back to OR on 8/28/19 for removal of prosthesis and antibiotic spacers placed (27488 and 11981).
My question is, for the DOS 8/28/19 would modifier 58 or 78 be used? Modifier 78 does not create a global period, therefore, the global period is coming from DOS 6/4/19. The procedure performed on 8/28/19 is a result of a complication but in the previous surgery (DOS 8/23/19) the provider notated that a staged procedure might have to be performed depending on the culture results.
The provider suggests billing with modifier 58 but I'm leaning towards modifier 78. When researching mod 58 vs 78, the material states these modifiers should be referenced back to the first procedure. According to the "first" procedure (DOS 6/4/19), DOS 8/28/19 is a complication. But if I look at the "previous" procedure (DOS 8/23/19), DOS 8/28/19 is a staged procedure.
Any thoughts on this is greatly appreciated
Thank you!
Patient developed infection and wound dehiscence. Patient returned to OR on 7/26/19 for partial revision of Total Knee Arthroplasty (27486) and wound dehiscence closure (13160). Modifier 78 added due to being a complication.
Patient developed another wound dehiscence. Patient returned to OR on 8/23/19 for wound dehiscence closure (13160). A culture was taken to determine if patient had infection and provider notated that if patient did have infection that patient would be brought back to OR for planned prosthesis removal with antibiotic spacers placed. Modifier 78 added to 13160 due to being a complication.
Culture came back with infection present. Patient brought back to OR on 8/28/19 for removal of prosthesis and antibiotic spacers placed (27488 and 11981).
My question is, for the DOS 8/28/19 would modifier 58 or 78 be used? Modifier 78 does not create a global period, therefore, the global period is coming from DOS 6/4/19. The procedure performed on 8/28/19 is a result of a complication but in the previous surgery (DOS 8/23/19) the provider notated that a staged procedure might have to be performed depending on the culture results.
The provider suggests billing with modifier 58 but I'm leaning towards modifier 78. When researching mod 58 vs 78, the material states these modifiers should be referenced back to the first procedure. According to the "first" procedure (DOS 6/4/19), DOS 8/28/19 is a complication. But if I look at the "previous" procedure (DOS 8/23/19), DOS 8/28/19 is a staged procedure.
Any thoughts on this is greatly appreciated
Thank you!