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Anesthesia Coding Alert

READER QUESTIONS:

For OR Return, Turn to Modifier 59

Published on Thu Jun 04, 2009

Question: A patient returned to the OR later in the day for post-op bleed following a small bowel resection with lysis of adhesions. The surgeon performed a splenectomy during the return to the OR. Medicare has denied claims for this type of situation in the past; I had to complete a phone review and use a 76 modifier. I have also seen that some coders recommend using a 59 modifier. Which modifier is correct? Wisconsin Subscriber Answer: The case you describe is a covered expense and should be reimbursed. Report modifier 59 (Distinct procedural service) with the diagnosis code for postoperative bleeding. Since the patient had a splenectomy, however, you might have another issue to consider. If the spleen was damaged during the small bowel resection, there may be a possibility the second surgery is considered a "never" event. There is also the possibility, however, that the damage was unavoidable [...]
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