General Surgery Coding Alert

See how one error can cost your practice plenty.

You learned how to choose the appropriate global-period modifier last month with "3 Tips Distinguish 58 and 78 to Impact Your Bottom Line" (General Surgery Coding Alert Vol. 14, No. 3).

Now you have a chance to quiz yourself to make sure you can save your surgeon lost revenue when she provides a related procedure during the postoperative period.

"You need to master when and how to use global period modifiers, or you could erroneously reduce the pay your surgeon receives for services following an initial procedure," says Marcella Bucknam, CPC, CCS-P, CPC-H, CCS, CPC-P, COBGC, CCC, manager of compliance education for the University of Washington Physicians Compliance Program in Seattle.

Make sure to consider the following modifiers as you try your hand at coding the following scenarios:

• 58 -- Staged or related procedure or service by the same provider during the postoperative period
• 78 -- Return to the operating room for a related procedure during the postoperative period.

Scenario 1: Neoplastic Breast Biopsy Leads to Mastectomy

Your surgeon performs an open breast biopsy for a 39-year-old female patient with a suspicious lump in the upper-inner breast quadrant.

Three days following surgery, the pathology report returned a diagnosis of infiltrating ductal carcinoma. The patient returned to surgery four days after the biopsy for a quadrantectomy procedure. Pathology findings for the second procedure confirmed infiltrating ductal carcinoma, with margins clear.

Scenario 2: Infection Following Breast Biopsy Leads to I/D

The surgeon performs an open breast biopsy for a 52-year-old female with a mass in the lower-inner breast quadrant. The pathologist reported findings of fibroadenoma.

Five days following the biopsy, the patient returned complaining that the incision site was warm to the touch, red, and swollen. Upon examination, the surgeon determined the presence of skin and soft tissue infection and an abscess requiring a return to surgery for a complex incision and drainage of the surgical site.

Try your hand at correctly coding these cases -- procedure, diagnosis, modifier, and all. Turn to page 27 to see how you did.