General Surgery Coding Alert

Question: An 83-year-old woman had a right hemicolectomy five weeks ago. She presented at this time with a subhepatic abscess (etiology obscure). There was no evidence of gastrointestinal leak. However, the patients gall bladder contained numerous stones and appeared acutely inflamed. The abscess was drained by open surgical exposure (to look for an anastomatic problem, but none was found). An open cholecystectomy also was performed. How do we code these procedures?

Anonymous Georgia Coder

Answer: All partial colectomies (44140-44160) have 90-day global periods, so any subsequent procedures or services performed during that time fall under the hemicolectomys global package unless they are unrelated to the original surgery, were planned ahead of time or are complications.

Planned or staged procedures performed during the global period need to have modifier -58 (staged or related procedure or service by the same physician during the postoperative period) attached, while a return to the operating room to handle either a complication or perform a related service would need modifier -78 (return to the operating room for a related procedure during the postoperative period).

Unrelated services, meanwhile, would take modifier
-79 (unrelated procedure or service by the same physician during the post-operative period).

In the scenario outlined above, the cholecystectomy probably should be coded 47605 (cholecystectomy; with cholangiography), says Karen Evans, RN, CPC, noting that 90 percent of the time, cholecystectomies are performed with cholangiograms. If no cholangiogram was performed, 47600 (cholecystectomy) would be the appropriate code. The abscess would require 47010 (hepatotomy; for open drainage of abscess or cyst, one or two stages). Both procedures would need a modifier -79, because they are unrelated to the original procedurethe hemicolectomy. In addition, 47010 would require modifier -59 to indicate it is a distinct procedure that should not be bundled into the cholecystectomy, Evans says.