Wiki Post op billing???

[herrera4]

ok I'm confused with a couple op reports for the same patient...

01/15/2013- partial colectomy, splenic fexure mobilization,adhesiolysis, repair small bowel tear

"small bowel tear occured during adhesiolysis"--44204, 44213

01/21/2013-segmental small bowel resection

"the site of previous enterotomy repair was the area of leak" this was also area that was resected--Can this be billed?? im thinking no

01/28/2013-drainage, repair of small bowel resection leak,ileostomy,feeding jejunostomy,debridement and wound VAC--patient dx includes septic shock

I am confused about billing the complications that came from the tear that occured during the original procedure.... Can anyone help me with guidelines for this type of post op billing?

Thanks for any info

 

[jdibble]

You can bill for a return to the OR during the global period - it is the E/M visits that are not billable if it is for the same diagnosis. You would need to append a modifier to your procedure code to show the reason for the return to the OR - 58 = staged procedure, 76 = repeat procedure, 78 = unplanned return by the same surgeon, 79 = unrelated procedure during the post-op period by the same physician, etc. In your scenario it sounds like these were complications and you would use modifier 78.

 

[herrera4]

thanks for the response--i understand the modifiers but my question is if the tear happened while the dr. performed the first surgery and the leak and other surgery that followed are for the tear--are they billable or no becuase she wouldnt have had them if the tear didnt happen?

 

[sheardmd]

Yes, we have always billed for this. These are complications of surgery and are billable with the 78 or 58 modifier if the 2nd and 3rd surgery were planned to fix the leak.

 

[jdibble]

Yes you can still bill for those procedures - you will probably add a diagnosis code to show what the complication was - like 998.2, Accidental puncture or laceration during a procedure.

 

[herrera4]

thanks