Wiki 78 vs 79 for different vertebrae

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owagner

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I'm having trouble understanding the answer/rationale for this case in Practicode. Patient had a procedure on upper thoracic vertebrae, then has another procedure for new compression fracture on lower thoracic vertebrae within the global period. The complaint of pain from the lower thoracic came after the upper thoracic procedure was done. Would the second procedure need a 78 because it's unexpected additional procedure in thoracic region? Or would it be 79 as the vertebrae involved are different from the previous procedure?

I've already submitted my answer and disagree with what Practicode has. I submitted my question to the "coaches" and as usual the response did not answer my question or address my reasoning. I would like to know how others would code this. Thanks.
 
I would tend to favor the 79 modifier because it is a different area of the thoracic spine and within the global period of the initial surgery.
If an additional procedure was required in the area of the initial surgery, I would probably go with the 78 modifier.

Tom Cheezum, OD, CPC, COPC
 
Would you be able to post the exact question with the procedures? I think it depends on what the diagnoses and procedures were.
 
amyjph said:
Would you be able to post the exact question with the procedures? I think it depends on what the diagnoses and procedures were.
Click to expand...
We are only given the note for the second procedure. It references the first procedure as "She has no tenderness at her previous vertebroplasty site. She has marked pain below this." The "coach" response seems to ignore this and highlights the patient had a procedure in the thoracic spine 3 days ago and came in with pain. That's why I'm wondering if individual vertebrae don't matter as much as if it's the same region of the spine.

I do not know if posting the exact case is allowed as it's from Practicode, a paid product. That may be crossing some copyright issue.
 
It seems they are trying to state the pain is related to the prior procedure. Yet, it also says she has no tenderness at the previous site. However, if there was a thoracic compression fracture treated with vertebroplasty, how would the fact that the patient had a second compression fracture be related? I would have used a 79.

I think a 78 would be incorrect. A new compression fracture at a different level wouldn't be a complication unless the provider directly linked it to the prior case. But, in this case that would make no sense. Plus, if the patient had a compression fracture at one level treated only 3 days ago, how come they didn't see the other compression fracture then? It's brand new? Maybe I'm reading into it too much but this is not a real world example.

Trying to learn with cases like this where it's incorrect has to be so frustrating especially when you are trying to understand.
 
Practicode is incredibly frustrating. Yes, I used 79, but it was marked wrong stating 78 as correct. I submitted a post coding note citing the same details as above, the vertebrae treated were different levels. The response I got cited the complaint of thoracic pain as reasoning to use 78.

This is just one example of Practicode's many issues. I also had to challenge an MDM level because it cited "leg pain" as low level problem in the rationale instead of the official dx of DDD and knee OA making it a moderate level problem.
 
amyjph said:
It seems they are trying to state the pain is related to the prior procedure. Yet, it also says she has no tenderness at the previous site. However, if there was a thoracic compression fracture treated with vertebroplasty, how would the fact that the patient had a second compression fracture be related? I would have used a 79.

I think a 78 would be incorrect. A new compression fracture at a different level wouldn't be a complication unless the provider directly linked it to the prior case. But, in this case that would make no sense. Plus, if the patient had a compression fracture at one level treated only 3 days ago, how come they didn't see the other compression fracture then? It's brand new? Maybe I'm reading into it too much but this is not a real world example.

Trying to learn with cases like this where it's incorrect has to be so frustrating especially when you are trying to understand.
Click to expand...
Ok I got another reply.



"Here, the previous vertebral augmentation procedure in thoracic spine is related to current pain developed due to pathological T11 fracture. Hence, it's related procedure in the post-op period. We can consider as unrelated when other unrelated diagnosis like ankle pain was treated in this visit."



So maybe I was supposed to infer the first procedure cause the fracture? That's not explicitly said. In fact it doesn't even explicitly say which vertebrae the first procedure was done on just not T11, the focus here. I did forget it was a pathological fracture. Does that make any difference? I feel I can squint and see the reasoning for 78 but that I have to make assumptions to do so
 
It's difficult without seeing the whole thing or specific case, unfortunately. If the patient had a vertebroplasty at T5 (example), returns 3 days later with pain lower down, and they find a compression fracture at T11, it makes zero sense to me that the 78 would apply. Maybe they are trying to say because it's pathological (caused by underlying disease process) that regardless of which vertebral body, because it was all thoracic it's all related. However, again, without seeing the specifics it's hard to be 100% certain. We could go back and forth all day long.
I think they are saying 78 because it was unplanned, yet related (same body area) but maybe not complication related.
 
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