recurrent inguinal hernia

bwerner

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A lady had her inguinal hernia repair done on 7/5/08 and now has a recurrence of the hernia at the same site or just inferior to it. He has to go back in to fix it again on 8/29/08. Would you use a -58 or a 78? 78 is going to reduce the service as -58 won't. Not sure if it should be reduced or what to do.:eek:
 
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A lady had her inguinal hernia repair done on 7/5/08 and now has a recurrence of the hernia at the same site or just inferior to it. He has to go back in to fix it again on 8/29/08. Would you use a -58 or a 78? 78 is going to reduce the service as -58 won't. Not sure if it should be reduced or what to do.:eek:
Hello,
Cpt 49520 ought to be given. It is a recurrent process and should be coded as a new procedure.
Modifier -58 is for staged procedure, only.
Modifier -78 is for return to the operating room for a related procedure during the postoperative follow up period.
Both these modifiers do not suit the situation described.
 

Treetoad

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If I were to code this service, I would use procedure 49520 with modifier 78. Technically, this is a complication. The complication is that the original procedure didn't work and the hernia returned.
 

aguelfi

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78

I'd use a 78 mod also. Return trip to OR. You may take a 20% hit but you're post op period doesn't start back over. You still use the original 7/5/08 date to start the 90 days from.
 

bwerner

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Thank you for the help. I was thinking 49520 with -78. How come your global period wouldn't start over? Is it because of the procedures being of the same hernia? Just wondering.
 

shelia_j

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Procedural Coder

DO not put -58 on it; however, if this patient had an unplanned return to the OR during the postoperative period, determine if the second surgery was a complication or was unrealted. If related, code the procedure as usual, but append the -78 modifier to denote that this was an unplanned return to the operating room during post/op period. IF it was not related to the first surgery and was truly a reoccurence, then code it as usual and append the 79/unrelated return to the OR during the postoperative period.
 

aguelfi

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post op period

That's what the 20% reduction in reimbursement is for. You're initially going to take a loss on the surgery but when the patient follows after the initially 90days post op period ends you can start to recoup your fees again. You're not penalized w/ a new post op for an unplanned return. This only applies w/ mod 78 though. 58 an 79 are exempt, 58 because it was planned and 79 because it's unrelated.
 

bwerner

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Thank you abenson for the information, it helped. To Shelia is states in his H&P for the second hernia repair that it was likely a technical defect leading to recurrence. I think I am going to use the -78 modifier. Thank you.
 

mbort

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I would definitely double check with the surgeon to see if it is truly related. If the hernia reoccurred due to something the patient did/didnt do, body habitius etc, you will be able to use the 79 rather than the 78. A reoccurence is not typically a complication of the previous surgery, its usually caused by something else.
 

bwerner

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mbort

Well, that is why I was confused because I didn't think that he should be docked with the -78 if it wasn't something he did wrong in the first surgery. He lets everyone know before hand of the complications and of course that it one. So, I will check with him, he is in surgery today so I will ask him on Friday. If he says it was nothing he did wrong I'll use -79 and if something went wrong with the first surgery then I will use the -78. Does the -79 not reduce his reimbursement but just starts the global over? Thank you for your imput.
 
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Was the first repair 49520?

I'm not clear from your original posting ... was the first hernia repair for an initial hernia repair, or was it also a recurrent?

If the earlier surgery also used CPT 49520, then you could use modifier 76 (repeat procedure).

Hope that doesn't further confuse you.

F Tessa Bartels, CPC
 

aguelfi

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yes

79 does start the global over and it does not reduce your remibursement. It dosen't have to be something the dr did in order for it to be related. It's the same hernia, on the same side w/in the 90 global...it's related. what code did you use initially?
 

mbort

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I do not believe that because its the same site (which the initial post indicated that it "could be" inferior to previous site), same side and within the 90 global that it is automatically "related" to the initial surgery.

I do believe however that there are several and certain conditions (that we are not aware of) that could effect the choice of modifiers used for this case.

I would still suggest checking with the surgeon to obtain additional information and documentation prior to making your decision on the use of the appropriate modifier.
 

bwerner

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On the first surgery I used dx 550.10 with 49507 because it was incarcerated.

I asked him about the second surgery. He said that the sutures pulled. The lady is 80 and wasn't doing anything strenuous. So, I think I am going with dx 550.91 with 49520-78.

Thank you for all the help.
 
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