Wiki Modifier 78?

[lnseda]

Hi all!

I have a case where a Medicare patient underwent a surgical procedure and was closed up. After the surgeon left the OR, the patient decompensated due to a complication and the surgeon returned to the OR. The surgeon reopened the patient and performed another procedure to resolve the complication. I have two questions

1. Is the second procedure billable?
2. If so, would you append modifier 78 even though the patient did not return to the OR (since they never actually left the OR to begin with)?

Thanks in advance for any information you can provide!

 

[csperoni]

1. Was the "complication" created by the surgeon? For example, did they accidentally injury the bowel which needed repair? You may not bill to repair your own mistake.
2. If the second procedure is billable and the patient never left the OR, I personally would bill it as one surgery. I don't recall seeing guidance specifically on this and was unable to find any. I am interpreting "return to OR" as the patient left the OR. -22 may be warranted since the surgeon closed, then re-opened the patient. If the patient had already been moved to recovery, then -78 seems accurate.

 

[lnseda]

1. Was the "complication" created by the surgeon? For example, did they accidentally injury the bowel which needed repair? You may not bill to repair your own mistake.
2. If the second procedure is billable and the patient never left the OR, I personally would bill it as one surgery. I don't recall seeing guidance specifically on this and was unable to find any. I am interpreting "return to OR" as the patient left the OR. -22 may be warranted since the surgeon closed, then re-opened the patient. If the patient had already been moved to recovery, then -78 seems accurate.

Thank you for your reply!

No, the complication was not created by the surgeon. The surgeon noted a hematoma was present during the initial procedure. The surgeon was called back to the OR after closing due to bleeding and clots. The surgeon reopened the patient and repaired an arterial bleed.

I also couldn't find any guidance on this scenario. I agree that modifier 22 may be the most appropriate route.

 

[thomas7331]

I agree with both of you - it is not a separate procedure and not a return to the OR if the patient never left the OR. It's the same operative session even if the surgeon left and later returned.