General Surgery Coding Alert

Test your coding knowledge. Determine how you would code this situation before looking at the box below for the
answer.   Question: A long-term patient had two toes amputated. During postoperative rounds the surgeon noted an ulcer on the calf of the same leg, which required debridement. Is the time spent debriding billable? New Hampshire Subscriber   Answer: Yes, you may bill for the debridement with the appropriate CPT code, e.g., 11040, Debridement; skin, partial thickness. Although the service takes place during the global period of another procedure (the amputation), it is unrelated to the initial surgery and therefore you may bill it separately. To indicate that the debridement is not part of the global surgical package of the previous procedure, however, you should append modifier -79 (Unrelated procedure or service by the same physician during the postoperative period) to the debridement code. In addition, an E/M service was required to identify the ulcer and decide that a debridement was the treatment of choice, and you may report the service separately in addition to the debridement itself. Documentation must support that a separate E/M service was indeed performed, and you should append modifier -25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to the E/M service to indicate that the service was beyond the minimal E/M component included in the debridement.

Also, add modifier -24 (Unrelated evaluation and management service by the same physician during a postoperative period) to the E/M code so it will not be included as part of the global fee of the previous procedure. You may use the same diagnosis for both the E/M code and the debridement.