Wiki Modifier for repeat vulvectomy

[such78]

Pt had right partial vulvectomy done 2 months ago ( 56620), and returned for left side this time with same diagnosis ( recurrent vulvar dysplasia/condyloma). The surgeon did not mention it was planned. Since it is still in 90 days global period, do I need to use modifier to indicate the left vulvectomy? ( I code for hospital)


Thank you for advice.

 

[csperoni]

I have zero experience with facility billing, but I always thought the global surgery package applied to the professional claim, not facility claims.
Per CMS global surgery booklet:
The global surgical package, also called global surgery, includes all the necessary services normally furnished by a surgeon before, during, and after a procedure. Medicare payment for a surgical procedure includes the preoperative, intra-operative, and post-operative services routinely performed by the surgeon or by members of the same group with the same specialty. Physicians in the same group practice who are in the same specialty must bill and be paid as though they were a single physician.
There may be other reference specifically for facility, but I do not think that IPPS and OPPS have global periods.
Someone familiar with institutional billing should feel free to set me straight.

 

[such78]

I have zero experience with facility billing, but I always thought the global surgery package applied to the professional claim, not facility claims.
Per CMS global surgery booklet:
The global surgical package, also called global surgery, includes all the necessary services normally furnished by a surgeon before, during, and after a procedure. Medicare payment for a surgical procedure includes the preoperative, intra-operative, and post-operative services routinely performed by the surgeon or by members of the same group with the same specialty. Physicians in the same group practice who are in the same specialty must bill and be paid as though they were a single physician.
There may be other reference specifically for facility, but I do not think that IPPS and OPPS have global periods.
Someone familiar with institutional billing should feel free to set me straight.

Because modifiers 58, 76, 77, 78, and 79 are also applied to ASC hospital outpatient use, so I think the global period is also applied to outpatient same day surgeries. Because it was done 2 months ago, now I coded same CPT codes with same diagnoses, insurance may think we bill duplicate.

 

[nielynco]

I have zero experience with facility billing, but I always thought the global surgery package applied to the professional claim, not facility claims.
Per CMS global surgery booklet:
The global surgical package, also called global surgery, includes all the necessary services normally furnished by a surgeon before, during, and after a procedure. Medicare payment for a surgical procedure includes the preoperative, intra-operative, and post-operative services routinely performed by the surgeon or by members of the same group with the same specialty. Physicians in the same group practice who are in the same specialty must bill and be paid as though they were a single physician.
There may be other reference specifically for facility, but I do not think that IPPS and OPPS have global periods.
Someone familiar with institutional billing should feel free to set me straight.

Pt had right partial vulvectomy done 2 months ago ( 56620), and returned for left side this time with same diagnosis ( recurrent vulvar dysplasia/condyloma). The surgeon did not mention it was planned. Since it is still in 90 days global period, do I need to use modifier to indicate the left vulvectomy? ( I code for hospital)


Thank you for advice.

I would think that the modifier -76 would be appropriate in this case as the same procedure is being repeated. The code itself does not specify whether it is unilateral or bilateral so no other modifier would be necessary.

 

[such78]

I would think that the modifier -76 would be appropriate in this case as the same procedure is being repeated. The code itself does not specify whether it is unilateral or bilateral so no other modifier would be necessary.

Thank you for your input. I did some researching for the modifier 76
.
Modifier 76 is used to report a repeat procedure or service by the same physician and is appended to the procedure to report:
Repeat procedures performed on the same day.
Indicate that a procedure or service was repeated subsequent to the original procedure or service.

 

[nielynco]

That is one interpretation, but not part of the CPT definition for this modifier. For instance, Medicare would require the use of a modifier -76 on a repeat screening Pap even though not on the same day.