Wiki Question about mult procedures on the same day

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Robin R

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A physician has two OP notes on the same date of service. First he is performing a DPL in the ICU. He says in the report, "we elected to proceed to the operation". Then, the second OP note is from the OR, he performs a small intestine resection.

The codes I am using are 49080 for the first procedure and 44120 for the second. Would you add some modifier to the 44120 to show that this was not done at the same time as the 49080? Or are they performed close enough that you can combine the OP notes (44120, 49080-51)?

Thank you!
 
The use of the 59 modifier will make the second procedure reduce in reimbursement as a discounted procedure. When two procedures are carried out on the same day but at different settings, we need to communicate this to the payer in order to bypass the discounting, in this instance the appropriate modifier will be the 78 appended to the second procedure. By doing this we have stated that the second procedure was in a different session and now both procedure should reimburse to the fullest extent.
Debra Mitchell, MSPH, CPC-H
 
Thank you Debra! Just a couple of questions though:

Can you put the 78 on the second procedure even though CPT 49080 does not have a global period? Also, won't the 78 modifier reduce reimbursement as well?

Thanks for any input you can provide!
 
No problem! You would need the 78 because it was on the same day and no the payment will not reduce. The reason for discounting--The intention of the payers is to reduce the second and subsequent procedure when performed in the same session, in other words they carve out of the second procedure the amount allowed for the prep. So when we can show by modifier that the second procedure was performed in a different setting, (return to the operating room) then the reimbursement for both procedures is all iot can be. There are four modifiers that do this, 76,77,78,79. The 58 is under review for this.
Debra Mitchell, MSPH, CPC-H
 
multiple procedures on same day

Hi:

Modifier 59 description in CPT manual clearly state that two procedures done in different sessions can go with modifier 59 appended to column 2 code. Modifier 78 does not look appropriate. I think it would help.

Girish Dadhich, CPC
 
More detail needs to be given to know for sure which modifier(s) is/are appropriate, but I don't believe it is 78.

Also, Modifier 78 does reduce the payment to only the amount associated with the intraservice RVUs for a code. Typically, the pre-op portion of the RVUs are worth about 10% of the code's RVUs, the intraservice about 70%, and the post-op about 20%, though the exact percentages change from code to code and a few codes (the Modifier 51-exempt ones) have no pre/post op work included and the fee is 100% intraservice work (only the operation/procedure itself).

So on average, using a 78 on a subsequent procedure reduces the reimbursement of the second procedure to about 70% of what the full code would have been paid-- a 30% discount. I doubt this is appropriate in your case, but can't tell for sure without knowing how the decision to do the 2nd procedure was made and if it was influenced by the findings of the diagnostic lavage. If it was decided based on the diagnostic lavage findings, then I would think that 58 would be used on the second procedure.

Seth Canterbury, CPC, ACS-EM
 
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