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Tricky/ Sticky one please help

  1. #1
    Johnson City
    Default Tricky/ Sticky one please help
    Medical Coding Books
    This is the situation:
    The surgery was Cholecystectomy with IOC. During the surgery the bile duct was misidentified as the cystic duct and was transected. The surgeon called in another surgeon(from the same practice), to repair it. The first surgeon's operation report states after he identifies the injury, " For the rest of the procedure, please see other surgeon's operative dictation. The second surgeon dictates this is a Consultation, but the report reads like an operation. He repairs the bile duct performs primary anastomosis, places a t-tube, and removes the gallbladder.

    Here are my questions:
    1. Typically if the injury is caused by the surgery being performed the repair is not billable, correct?

    2. Both surgeons are from the same practice, bill with the same tax ID#, group NPI...

    3. The repair was performed during the same operative session. The first surgeon did not close then call the second surgeon to come in. So I don't think modifier 78 would work, if I were to bill for the repair. Correct?

    4. Should I bill the cholecystectomy for the first surgeon, and consultation only for the second surgeon, that just doesn't seem right to me because the second surgeon did so much work. ????????

    Any suggestions would be helpful.


  2. #2
    What about billing the whole thing with an assistant surgeon??

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