Orthopedic Coding Alert

Question: A surgeon who isn't in our group performed a left total hip replacement three weeks ago on a 67-year-old female patient. The cup has since migrated into the pelvis because of poor bone quality, causing pain and dysfunction. The cup essentially failed. Our surgeon performed the revision. Do I need to append a modifier because the patient is in a global period with the other provider?

Pennsylvania Subscriber

Answer: Because another group performed the previous surgery, you do not need to append a modifier to indicate the service is separately reportable during the global period.

Example: If the surgeon performs a total hip revision for the acetabular component only, you should report 27137 (Revision of total hip arthroplasty; acetabular component only, with or without autograft or allograft) without appending a modifier that indicates the procedure was a return to the operating room for a complication. You should also report the appropriate diagnosis code, based on the surgeon's documentation, such as 996.43 (Prosthetic joint implant failure) and V43.64 (Organ or tissue replaced by other means; joint; hip).

Reason: For Medicare, the global period does not include another physician's services, except where the surgeon and other practitioners agree on a transfer of care.

Remember, "A transfer of care occurs when a physician or qualified NPP requests that another physician or qualified NPP take over the responsibility for managing the patient's complete care for the condition and does not expect to continue treating or caring for the patient for that condition," the Medicare Internet Only Manual (IOM) states.

In a transfer of care, the receiving physician or qualified NPP would report the appropriate new or established patient visit code, according to the place of service and level of service performed, and should not report a consultation service, the IOM says.

Note that the modifiers you would typically use during the global period, such as modifier 78 (Unplanned return to the operating/procedure room by the same physician following initial procedure for a related procedure during the postoperative period), include the phrase "by the same physician." You are not reporting a procedure by the same physician, so not appending one of these modifiers makes sense in this case.

Resource: You can find more information on Medicare's global surgical rules in the Medicare Claims Processing Manual, chapter 12, section 40 (http://www.cms.hhs.gov/manuals/downloads/clm104c12.pdf).

-- Reader Questions and You Be the Coder were reviewed by Heidi Stout, CPC, CCS-P, director of orthopedic coding services at The Coding Network LLC; and Bill Mallon, MD, orthopedic surgeon and medical director at Triangle Orthopaedic Associates in Durham, N.C.