Wiki Does this modifier/code really exist?????

[lkyoung]

We were taught if a physician creates a defect during another surgical procedure the repair was included in the intended procedure.

We were recently told there is a diagnosis or modifier the physican can use to bill for the repair of what they caused.

Example - doctor creates paraesophageal hernia during the placement of a lap band - 43770. They are being told there is a modifier they can use to enable their billing of a lap paraesophageal hernia repair - 43281.

Is this correct?

 

[Shrina]

I think you are talking about modifier 78 - unplanned return to the operating room during a postop period. This is the modifier used for procedures for repair of complications. This is a modifier that goes with the procedure code (cpt). Diagnosis codes don't have modifiers. You might want to look at 539.09 for dx.

 

[lkyoung]

Shrina: I am actually looking for a code that can be used at the same operative session to fix a physician created defect. I am doubtful this exists, however, we have been instructed to look for its possible existence...

 

[Kisalyn]

Who is telling you there is an appropriate diagnosis or modifier? The insurance company?

 

[lkyoung]

Kisalyn: My manager was having a discussion with another certified coder who stated they existed...lisa