Wiki Thoracentesis during 90 global for CABG....need help!

[sjwillis]

Hi...I am new to cardiothoracic coding and I am wanting to know if you can bill for the following scenario.

Patient is in a 90 day global for a heart procedure....CABG, valve replacement, ect. Patient is discharged from hospital and then comes into clinic for follow up visit and then diagnosed with a pleural effusion. A thoracentesis is performed in the office. Clinic is currently billing for the surgical tray which always denies as inclusive. They were told to do this by a coding workshop. I reviewed the article the clinic was referencing and it specified that the surgical tray was no longer billable and that a thoracentesis was also included in the gloabl period and should not be billed. However, I cannot find any supporting information to confirm this. Since I am new to cardiothoracic I did bill the 32421during a global and received payment from both Medicare and UHC. I have spoke to inpatient facility coders and they state that you can bill for a 32421 since facilities are not under global restrictions. So....should my physicians be billing for a thoracentesis during a global period when performed during a follow-up office visit? Opinions......thanks!

 

[jewlz0879]

With a 78 or 79 modifier. And yes you can bc you have a different dx. Make sure you don't bill 414.01 with that, if that was your dx for the CABG. If you do, make sure the 414.01 is not a primary dx.

 

[sjwillis]

Thank you for responding. I had thought about mod 79, but I wasn't sure if a pleural effusion was not related to a CABG. From everything I have read about the CABG procedure it seems that pleural effusions are quite common, however, the large effusions that require thoracentesis are less common. I wouldn't use mod 78 since these are being done in office and the patient is not going back to the op room. What do you think about mod 58? Modifier 58 states to use for 1) a staged or anticipated procedure, 2) or a more extensive procedure than the original, 3) or for therapy following a surgical procedure. I think that a thoracentesis could fall under an anticipated procedure if a pleural effusion were to arise that required intervention since it is a pretty common problem that occurs after a CABG. Or perhaps for therapy following a procedure since the thoracentesis is done to remove trapped fluid causing discomfort. Any thoughts?

With a 78 or 79 modifier. And yes you can bc you have a different dx. Make sure you don't bill 414.01 with that, if that was your dx for the CABG. If you do, make sure the 414.01 is not a primary dx.

 

[lisigirl]

I tend to think pleural effusions, after a chest procedure, are a complication related to the surgery and you would use modifier -78 when performed in the OR. I'm not so sure a thoracentesis performed in the office would be separately billable...

For sure, if the patient has Medicare, you can only bill for related procedures if the patient is taken back to the OR however, for private payers, it depends on if they follow CPT's surgical package definition or Medicare's definition.

As for modifier -58, that would not be appropriate. Modifier 58 is indicating that you either planned this thoracentesis at the time of the cabg or that this thoracentesis is a more extensive procedure than the cabg, which its not. (Examples of when you would use this modifier would be (1) if the surgeon left the chest open and then took the patient back to the OR a day or so later to close it - 21750-58 for a planned procedure or (2) a patient has wedge resection of the lung and is then taken back in the global period to remove the entire lobe - 32480-58 for a more extensive procedure).

Not sure if I was any help - LOL.

Lisi, CPC
eharkler@nmh.org