Neurosurgery Coding Alert

Question: A Medicare patient had an evacuation of a subdural hematoma (61154). Twenty-three days later, he had a re-evacuation, which I coded 61154-76. Medicare is denying the procedure as part of the previous surgery's global package. Any suggestions? Neurosurgery Discussion Group Participant Answer: The global period for 61154 (Burr hole[s] with evacuation and/or drainage of hematoma, extradural or subdural) encompasses all normal patient care, including E/M services and "routine" complications, beginning the day prior to surgery and extending for 90 days. In this case, however, the re-evacuation within the global period was not routine, and you may therefore report 61154 a second time. Modifier -76 (Repeat procedure by same physician) seems the reasonable (and most accurate) choice in this circumstance, but few payers recognize this modifier for surgical procedures because payment decisions depend on whether a subsequent procedure is related or not. Resubmit with modifier -78 (Return to the operating room for a related procedure during the postoperative period) appended to 61154 to describe the return to the operating room. Be sure to include documentation that proves that the return to the OR was medically necessary. Clinical and coding expertise for You Be the Coder and Reader Questions provided by Eric Sandham, CPC, compliance educator for Central California Faculty Medical Group, a group practice and training facility associated with the University of California at San Francisco in Fresno.