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kellit21

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Patient was seen 2 weeks ago for a total hip arthroplasty... she was admitted by our physician for a hip dislocation of the same total hip arthroplasty. Can we bill for the admission, and if so what modifier is appropriate?
 

OCD_coder

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You cannot bill complications unless they go to the OR. So the dislocation surgical procedure would be billable with a modifier 58. The admission E&M codes are not billable to MCR or other payors that follow the same rules.

Modifier 78 is for an unplanned trip more for an unrelated problem. Dislocation of the same hip is related to the THA and a modifier 58 is more appropriate for a .... more extensive reason...

Source: http://www.aaos.org/news/aaosnow/may09/managing1.asp
 
Last edited:

kellit21

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Thank you so much for your response!!!
What modifier would I use on the E&M if the Dr admitted the patient and took the patient back to the OR?
 

kellit21

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I am sorry, let me make sure I was clear as to what happened with this patient.
Patient had a total hip arthroplasty 2 weeks ago... Came in to the ER with a dislocation of that same hip... we admitted the patient and took the patient back to the OR for a revision of the total hip arthroplasty...

Can we bill for the admission?
Would you still use the 58 modifier on the revision operation?
 

OCD_coder

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I am sorry, let me make sure I was clear as to what happened with this patient.
Patient had a total hip arthroplasty 2 weeks ago... Came in to the ER with a dislocation of that same hip... we admitted the patient and took the patient back to the OR for a revision of the total hip arthroplasty...

Can we bill for the admission?
Would you still use the 58 modifier on the revision operation?
Repeat answer:The admission E&M codes are not billable to MCR or other payors that follow the same rules.

Repeat answer: Dislocation of the same hip is related to the THA and a modifier 58 is more appropriate for a .... more extensive reason...
 
Last edited:

nyyankees

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Patient was seen 2 weeks ago for a total hip arthroplasty... she was admitted by our physician for a hip dislocation of the same total hip arthroplasty. Can we bill for the admission, and if so what modifier is appropriate?
Was there a new injury (i.e. patient fell, etc.)? If not no E/M and 78 modifier.
 
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