Wiki Surgery in Global Period

[LLRodgers]

Hello,

I have one that is in the 90 day global period for surgery for a meniscal tear. Patient came in for a follow up, they had an effusion, I codded it as followed.

M96.89 - Other post procedural complication and/or disorder of a musculoskeletal system/procedure
M25.462 - effusion
G89.18 - Other Acute Post-procedural Pain
20610-LT-58 - Injection
J1040 - 80 Depo Medrol
99024

This is being denied for post op include in surgery. surgery was for a meniscal tear and he developed an effusion and doctor did an injection. Can anyone tell me if I coded this correct or is this considered pain management due to surgery.

Any help is appreciated.

Thank you,
LLR

 

[Orthocoderpgu]

The first thing you need to do is look at the insurance being billed. If it is Medicare, or a Medicare policy, they will not pay for complications within a global unless the patient returns to the OR. Private insurance will usually pay for things like this but it is hit and miss. Your modifier -58 is incorrect, that means that your doc KNEW that this would need to be performed after the initial surgery. I would try -78.

 

[tsahoney78]

Modifier 58 is for staged
Modifier 78 is for related
Modifier 79 is for unrelated

I would definitely try the modifier 78. It should pay at a reduced rate.

 

[flipflop40@verizon.net]

if this was a "complication" from the arthroscope, then it is all included in the global period. Management of pain is included in the post op period.
Modifier 78 is used for a return to the OR for a complication from the surgery; your scenario is not a return to the OR.

 

[thomas7331]

Agree, modifier 78 is for a return to the OR, it is not just for any related procedure. It would be an inappropriate modifier if that procedure was not done in the OR.