Wiki flap/ATT Mohs complication/bleeder

[Texascoder64]

A pt underwent MOHS and Adjacent Tissue Transfer and a day later had bleeding, the physician had to add some more sutures. Then the next day the patient returned again with more bleeding and the physician took down the entire flap/att and completely re-did the flap. I believe the first day with the bleeding problem was more of a wound dehiscence code 13160 -79 to use, but for the take down and re-do of flap - would that be coding the ATT again with what modifier? (this is done in our office setting) 78 or 79 mod?

thank you

 

[CatchTheWind]

Theoretically, the modifier would be 78 (unplanned return to the operating room). However, Medicare and any payers who follow Medicare guidelines only allow this modifier to be used if the operating room to which you are returning is an actual OR. If you are repeating the procedure in-office, the service is included in the global package.

See http://www.cms.gov/Outreach-and-Edu...oducts/downloads/GloballSurgery-ICN907166.pdf which says:
?The global surgery payment includes? all additional medical or surgical services? during the post-operative period of the surgery because of complications, which do not require additional trips to the operating room?. An OR, for this purpose, is defined as a place of service specifically equipped and staffed for the sole purpose of performing procedures.... It does not include... a minor treatment room....