General Surgery- billing seroma

AWenger

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I have recieved denials for Medicare for billing post op seroma ICD-9 for a FNA following a hernia repair. I billed the CPT with a -78. Since we are returning to the OR i thought we could get paid for these. Can anyone help with billing for post op seromas? Can we get paid or do we have to take a write off?

Thank you!
 

AWenger

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There were two claims. Both with CPT 10021-78
the icd-9 on one was 998.51 and the other was 998.13

CO-4: The Denial read: The procedure code is inconsistent with the modifier used or a required modifier is missing.

Thank you!
 

dpeoples

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There were two claims. Both with CPT 10021-78
the icd-9 on one was 998.51 and the other was 998.13

CO-4: The Denial read: The procedure code is inconsistent with the modifier used or a required modifier is missing.

Thank you!
Using modifier 78 implies the procedure was performed during the global period of the initial surgical procedure, the rejection implies the payor may not recognize the global period. Verify that the post op seroma aspiration was during the global, if so, appeal with documentation.

HTH :)
 

mitchellde

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First to use 998.51 you need to add a code for the infective organism. Second it is possible they are wanting you to use the 79 modifier instead. While you and I see it as related, others say that because the original incision was undisturbed it is unrelated. Also the second time the patient had to return for the seroma I would lean toward the 58 modifier as a planned procedure. Just a thought.
 
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AWenger

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ok. The claims were acutally for two different patients. I might do the-79. Thanks!
 
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