ECMO decannulation - need help with modifier

dellasanta

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a patient had a repair of atrial septal defect (33641) and later was put on ECMO. 10 days after the repair, we did decannulation and placement of a central line in the ECMO procedure room, not the OR. Is this billable and if so, what mod is appropriate? 58 or 78? Thanks for the help
:confused:
 
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Contingent on documentation

58 is applicable if it was a planned return. 78 is unplanned return, 79 is unrelated to the procedure that has a global period.
 
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ECMO decannulation

a patient had a repair of atrial septal defect (33641) and later was put on ECMO. 10 days after the repair, we did decannulation and placement of a central line in the ECMO procedure room, not the OR. Is this billable and if so, what mod is appropriate? 58 or 78? Thanks for the help
:confused:

Modifier 58 is typically correct as the decannulation would always be anticipated at the time of initiation of ECMO. The use of the procedure room should be sufficient just as a cath lab or endoscopy suite would be considered appropriate for the use of modifiers 58 and 78 based on Medicare's definition of operating room, " Treatment for post-operative complications requiring a return trip to the Operating Room (OR). An OR, for this purpose, is defined as a place of service specifically equipped and staffed for the sole purpose of performing procedures. The term includes a cardiac catheterization suite, a laser suite, and an endoscopy suite. It does not include a patient’s room, a minor treatment room, a recovery room, or an intensive care unit (unless the patient’s condition was so critical there would be insufficient time for transportation to an OR), it is likely that the procedure room meets this description." Payer requirements may vary but most align with CPT and/or Medicare.

I hope that is helpful.
Cindy
 
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