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Ethical question

  1. #1
    Default Ethical question
    Medical Coding Books
    I have a surgeon who wants to bill for a repair of an esophagus tear that was caused by a Resident she was supervising while doing a celiac access lymph node biopsy. Can she do that?

  2. Default
    All services must be billed, the question is HOW. I believe the modifier 78 would be in order, correct me if I'm wrong specifies same surgeon, but I believe your attending is considered the physician of record for both surgeries.

  3. #3
    Default Ethical question
    Usually when a surgeon tears or fractures anything during a surgery you can not bill to the insurance for your mistake regardless of a resident or MD performing the repair. You can bill the repair code as part of the medical record, but has to have a zero charge.

  4. Default
    I believe modifier 78 carries a 0 charge since it is for a related procedure in the global period.

  5. #5
    Milwaukee WI
    Default Mod 78 has nothing to do with charge
    Quote Originally Posted by dtowne View Post
    I believe modifier 78 carries a 0 charge since it is for a related procedure in the global period.
    Mod 78 has nothing to do with the charge. It simply describes the circumstances under which a return to the OR was required during the global period.

    There are MANY cases where -78 mod is used and there is a charge associated with the service.

    Now ... as to the original question. We would NOT charge for a repair of an injury caused by our own surgeons (or residents). The surgeon would definitely dictate an operative note regarding the repair. We might code it to complete the medical record. But we would not charge a fee for that part of the service.

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

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