Wiki CRNA coding question help

[akj]

I have a patient who had a hip replacement due to arthritis. Coding for the CRNA services, I used CPT 01214 with dx M1612. Later the same day, the patient dislocated the new hip and was taken back to the OR for revision. I billed a second case with CPT 01215 with dx T84021A. The 01215 denied by Medicare, and the biller sent in documentation detailing the two separate cases. Medicare came back and denied again stating the claim was originally processed correctly and therefore they will not be making an adjustment due to "code 01214 (column 1) has a CCI conflict with code 01215 (column 2). A modifier is not allowed to override this relationship."

I was thinking about using mod 59 on the 01215, but it looks like Medicare is saying I cannot?

 

[cgaston]

I think a -78 modifier (unplanned return to the OR by the same physician...for a related procedure) is more appropriate than a -59.

 

[akj]

From what I am reading, mod 78 would be used by the surgeon who brought the patient back to the OR during a global period. Anesthesia doesn't have a global period, so modifier 78 wouldn't apply?

It doesn't happen often, but when we have a patient return to the OR on the same day, it has been sufficient to provide the anesthesia records that document the different start and stop times for proof of separate cases.

 

[asimanson84]

we always use the -59 mod for return to OR on same day