Gastroenterology Coding Alert

Question: Our gastroenterologist conducted a partial colectomy with closure of the distal segment on a patient.
 
The patient did not properly care for the wound, and three days later he returned to the office for treatment of the surgical wound because he had a serious infection at the incision site. The physician returned the patient to the operating room, removed the infected tissue and re-dressed the wound. How should I code this claim?

Virginia Subscriber

Answer: You should report - and be reimbursed for - both services. For the initial colectomy, report 44143 (Colectomy, partial; with end colostomy and closure of distal segment [Hartmann type procedure]). Because the second surgery was prompted by a complication from the initial surgery, append modifier -78 (Return to the operating room for a related procedure during the postoperative period) to 13160 (Secondary closure of surgical wound or dehiscence, extensive or complicated).
 
Although the colectomy has a 90-day global period, treatment of an infection during the post-op period is not covered by the global umbrella, so you can report it. Be sure that there is a return to the operating room (OR) before using modifier -78; as the definition indicates, the patient must return to the OR for the modifier to be properly employed.