Orthopedic Coding Alert

Hint: Repeated debridements are often staged' Whether your group is left footing the bill for a surgical procedure during the postoperative period can hinge on your ability to choose the correct modifier. Spot these characteristics to choose modifier 58, 78, or 79 to get these claims through payers- edits. 1. If Dr. A returns the patient to the OR for an anticipated, staged, or more complicated problem, append modifier 58 to the codes. This allows 100 percent reimbursement and the global period starts over. Repeated debridement of wounds; open fractures; and application, adjustment, or removal of fixations devices could all fall into this category. The return is not associated to the first "procedure" and the second procedure is staged, anticipated, or more difficult and related to the patient's condition after the trauma. 2. If Dr. A performs a procedure unrelated to the initial procedure in a different session (for example on day two), use modifier 79 (Unrelated procedure or service by the same physician during the postoperative period). Watch out: If the subsequent procedure is related to the initial "procedure," as in the case of a postoperative hematoma, this would warrant modifier 78. Medicare pays procedures with modifier 78 at approximately 69 percent and the global period is not changed. This would be an unanticipated trip back to the OR for complications related to the original procedure. Remember once a global is established by Dr. A, all other procedures performed within the 90 day global will need a modifier, otherwise the claim will be denied for payment. This applies to all providers within the same group specialty with the same group tax ID number. Do this: To prevent denials and additional back end work, establish a mechanism to alert the coding department that someone in the practice has established a global. This may look like a review of modifiers, however, you see how the multiple wounds and trips to the OR are all linked to that first primary procedure by each physician.