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repeat total hip replacement

thegoseys

Guest
Messages
1
Best answers
0
I don't know alot about ortho coding so if someone could help I would appreciate it.
My 81 year old mother broke her hip and had a replacement. 6 weeks later she dislocated her hip twice in a week. They decided they needed to go back in so they did surgery, removed old hardware and replaced with new longer rod. They coded 27138 which is correct and a 20680 and 26990. Insurance paid everything except the 20680 they denied because service was included in another service provided at the same time. I know a modifier needs to go on there, but not too sure which. It was about 8 weeks between 1st surgery and second surgery so it was less than 90 days. She passed away about 5 weeks later unfortunately and they are saying we owe the denied amount, which is incorrect because the office coded it wrong.
Sorry this is so long, but wanted to give all info.
thanks!
 

lewisbr

Networker
Messages
32
Best answers
0
Hi i have been doing ortho coding for a over a year now and we have run into situations like this where the physician has had to go back in before the 90 global period is up, and it is not up to the patient to figure out what modifier needs to be appended, the office does and it they cannot figure it out then you are not responsible for the bill, we would use the modifier 78 unplanned return to the OR by the same physician or other qualified health professional following the initial procedure for a related procedure during the postoperative period, now if that does not work, then they can always append -59 distinct procedure hope this helps. Sorry for your lost but make sure you stay on this office to get this correct!
 

primrose1

Guru
Messages
120
Location
Albion, NY
Best answers
0
The doctor's office is incorrect. Removal of the hardware (20680) is part of the revision code 27138. They should not be re-imbursed for this code nor should they be billing you for it!!!
 
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