Orthopedic Coding Alert

In the December 2000 issue of Orthopedic Coding Alert in the article Understand Significant 2001 Orthopedic Coding Changes for Proper Reimbursement on page 95 we said that modifier -60 (altered surgical field) would be appropriate for surgery on a morbidly obese patient, which significantly complicates the surgical dissection. According to CPT Changes 2001: An Insiders View, published by the AMA, modifier -60 should not be used for morbid obesity. The book lists several scenarios when it is not appropriate to use -60. These include:

hernia mesh repair (when not included in the code descriptor)
morbid obesity
lysis of extensive adhesions NOT due to late effects of prior surgery, irradiation, infection or trauma
an alteration in the patients cognitive capacity (e.g., Alzheimers)
patients physical impairment
increased time to complete procedure
additional x-ray views not otherwise classified in radiology
when laparoscopy requires minilaparotomy or with secondary procedures involving significant time and effort.