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Return to OR during 90 day global, E&M?

  1. #1
    Default Return to OR during 90 day global, E&M?
    Medical Coding Books


    When a patient returns to surgery within the original 90 day global is an E&M for the initial Hospital visit chargeable or just the CPT for the procedure itself?
    (2nd procedure is performed by a surgeon belonging to the original surgeon's group)

    Example: Patient had a bowel resection 15 days ago and now returns with an anastomotic leak. Patient is returned to surgery for another resection and abscess drainage.

    Am I to charge only the procedure CPT or both the procedure and E/M for the initial hospital visit?

  2. Default
    You could code the initial E/M for the new admit point to icd for the post-op abcess for the medical necessity, and append mod 57, decision for surgery; most payers will deny/reject as part of the global for the return to operating room. Append modifier 78, unplanned return to operating/procedure room within the post-operative period by the same surgeon or other qualified healthcare professional. The payer should cover the second procedure, but including or attaching the operative narrative never hurts. Of course, dont' forget to obtain pre-certification if managed care is involved!

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