Orthopedic Coding Alert

Question: Our patient underwent a hemi-arthroplasty for a fractured hip. He returned to the nursing home and fell 60 days later, resulting in dehiscence of his surgical wound. He was readmitted for incision and drainage (I&D) of the wound. Is this related to the original procedure (and therefore part of the global period), or is it considered unrelated?

Texas Subscriber

Answer: Most coding consultants agree that the I&D is a related procedure, since the surgeon performed it to repair a dehiscence of the original surgical wound. Even though the fall was technically the cause of the problem, your patient would not have required the I&D if he hadn't had the original surgery.
 
Assuming that your surgeon closed the wound dehiscence, you should report 13160 (Secondary closure of surgical wound or dehiscence, extensive or complicated) with modifier -78 (Return to the operating room for a related procedure during the postoperative period) appended. You should report 998.3x (Disruption of operation wound) as your diagnosis code.