Gastroenterology Coding Alert

Question: A patient has hemorrhoids and my gastroenterologist cauterizes three internal hemorrhoids with a heater probe. The next day the patient calls complaining of severe rectal pain. The gastroenterologist returns the patient to the operating room for a flexible sigmoidoscopy and discovers the patient has bleeding in the hemorrhoid-removal area. The gastroenterologist uses a heater probe to stop the bleeding. How should I code for this encounter? Oregon Subscriber Answer: Since the patient returned to the operating room (OR) for a subsequent procedure directly related to the hemorrhoid removal during the global period, you will need to use modifier 78 (Unplanned return to the operating/procedure room by the same physician following initial procedure for a related procedure during the postoperative period). That modifier will tell your payer that the second procedure involved a return to the OR to treat complications during the global period of an earlier procedure (the hemorrhoid [...]