Wiki Postop Period Same Site Reinjured Billing

[ksobota]

Ortho Surgeon. Medicare patient.
07/23 Pt fell and fractured her patella. Doctor did ORIF
08/29 Pt fell in post op period and tore patellar tendons that were repaired by the same Doctor.
09/06 Pt fell in post op period again and had a retear of tendons per the dictation from the same Doctor. They are not going to repair it now.

Would we bill the 09/06 as a new injury for this since it occurred from a different fall? Just want to make sure if Modifier 24 would be appropriate for this situation since it's the same site (appears that way at least from the dictation) but a new/reinjury situation as they had previously been repaired?
Thank you!

 

[amyjph]

In this case the office visit during the global would probably be billable w/ a 24 (my opinion) during the post op. It was not a planned post op visit, the patient fell and had a "new injury" even though in the same anatomic area. If they did an ORIF for a fractured patella initially and that was all. If the second visit was for a patellar tendon tear that's different even if the same body area. The third, even though the same area, was caused by a fall not related to a surgical complication. The documentation would have to be really clear and you would want to make sure it meets the modifier 24 requirment. You would want to double check all the diagnoses.
Think of it this way - these are not normal post-op related issues to an ORIF of the patella. Would the patient have come back in for these visits otherwise or just for the routine post op visits? The surgery to repair the patellar tendons would be billable too.

 

[ksobota]

Appreciate your input! We had the same opinion in the office here but were just unsure and wanted to double check with our coder world. Thank you!