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recurrent inguinal hernia

  1. #1
    Cool recurrent inguinal hernia
    Medical Coding Books
    A lady had her inguinal hernia repair done on 7/5/08 and now has a recurrence of the hernia at the same site or just inferior to it. He has to go back in to fix it again on 8/29/08. Would you use a -58 or a 78? 78 is going to reduce the service as -58 won't. Not sure if it should be reduced or what to do.

  2. Default
    Quote Originally Posted by bwerner View Post
    A lady had her inguinal hernia repair done on 7/5/08 and now has a recurrence of the hernia at the same site or just inferior to it. He has to go back in to fix it again on 8/29/08. Would you use a -58 or a 78? 78 is going to reduce the service as -58 won't. Not sure if it should be reduced or what to do.
    Hello,
    Cpt 49520 ought to be given. It is a recurrent process and should be coded as a new procedure.
    Modifier -58 is for staged procedure, only.
    Modifier -78 is for return to the operating room for a related procedure during the postoperative follow up period.
    Both these modifiers do not suit the situation described.

  3. Default
    If I were to code this service, I would use procedure 49520 with modifier 78. Technically, this is a complication. The complication is that the original procedure didn't work and the hernia returned.

    ~L
    CPC, CGSC, COSC

  4. #4
    Default 78
    I'd use a 78 mod also. Return trip to OR. You may take a 20% hit but you're post op period doesn't start back over. You still use the original 7/5/08 date to start the 90 days from.
    adrianne, cpc

  5. #5
    Default
    Thank you for the help. I was thinking 49520 with -78. How come your global period wouldn't start over? Is it because of the procedures being of the same hernia? Just wondering.

  6. Default Procedural Coder
    DO not put -58 on it; however, if this patient had an unplanned return to the OR during the postoperative period, determine if the second surgery was a complication or was unrealted. If related, code the procedure as usual, but append the -78 modifier to denote that this was an unplanned return to the operating room during post/op period. IF it was not related to the first surgery and was truly a reoccurence, then code it as usual and append the 79/unrelated return to the OR during the postoperative period.

  7. #7
    Default post op period
    That's what the 20% reduction in reimbursement is for. You're initially going to take a loss on the surgery but when the patient follows after the initially 90days post op period ends you can start to recoup your fees again. You're not penalized w/ a new post op for an unplanned return. This only applies w/ mod 78 though. 58 an 79 are exempt, 58 because it was planned and 79 because it's unrelated.
    adrianne, cpc

  8. #8
    Default one more thing
    make sure you use the dx for recurrent hernia 550.XX
    adrianne, cpc

  9. #9
    Default
    Thank you abenson for the information, it helped. To Shelia is states in his H&P for the second hernia repair that it was likely a technical defect leading to recurrence. I think I am going to use the -78 modifier. Thank you.

  10. #10
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    Default
    I would definitely double check with the surgeon to see if it is truly related. If the hernia reoccurred due to something the patient did/didnt do, body habitius etc, you will be able to use the 79 rather than the 78. A reoccurence is not typically a complication of the previous surgery, its usually caused by something else.

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