Case Study:
Optimize Reimbursement When Assistant Surgeon Takes Over Management of Patient
Published on Fri Oct 01, 1999
"Global periods for major procedures apply only to the surgeon who performed the initial surgery, not to other surgeons who may have assisted with the procedure. In the following case study, a general surgeon who assisted with a radical cystectomy and a right nephrectomy nine days earlier has taken over care of the patient, who needs to return to the operating room. Since the assistant surgeon then is the main surgeon, billing for the new procedure(s) will differ from what it would have been had the same surgeon been in charge of both sessions. Our coding experts will discuss which procedure codes and modifiers should be used and the diagnosis codes associated with the procedures.
Note: Before charging for any procedure, office staff need to carefully check both the operative and pathology reports as well as talk with the physician who did the surgery. Coders should never bill for a procedure unless they have read the entire op report.
Operative Report
Preoperative Diagnoses: Perforated hollow viscus. Poor peripheral veins.
Postoperative Diagnoses: Disrupted ileal anastomosis with peritonitis. Poor peripheral veins.
Procedure: Exploratory laparotomy with small bowel resection and functional end-to-end anastomosis.
Estimated blood loss: 400 cc.
History: The 73-year-old man underwent a radical cystectomy and right nephrectomy nine days ago for CA of the bladder. He had a postoperative stroke but had been doing well. Had x-ray done for placement of a Dobhoff tube today, which showed free air into the diaphragm. Examination of the abdomen revealed tenderness and distention, and his white blood count was elevated. He was brought to surgery for exploration. His peripheral veins are pretty well used up, and he requires reliable venous access.
Operative Procedure: Under satisfactory general endotracheal anesthesia and the patient in the trendelenburg position, the chest and neck were prepped and draped. The skin lateral to the junction and clavicle and first rib was incised. A thin-walled needle was passed into the subclavian vein and a guidewire advanced easily. The dilator followed by the quad lumen catheter were passed over the guide wire and sutured. The tip of the catheter was positioned just above the right atrium using fluoroscopy. The catheter was sutured in place and Betadine followed by a gauze dressing applied.
The abdomen was then prepped and draped. The steri-strips had been removed. The previous mid-line incision was opened and the abdomen entered. The abdomen was explored, with a small amount of stool noted in the left lower quadrant. The small bowel was then dissected out with all the adhesions freed up. The bowel was brought up out of the pelvis. The leak was found to be at the end of the previously stapled functional and end anastomosis. There was no [...]
