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44120 or 44121 return to OR same day

Stephanie Posted Thu 06th of February, 2020 17:19:00 PM
Hi, I'm not sure if I billed this correctly. The doctor performed a 44120 resection of the small bowel in the morning. Later that day, they brought the patient back to the OR due to complications. Approximately 15cm from the previous anastamosis she located a perforation in the small bowel. Due to the appearance she performed another resection. Should I have billed this all one claim and used add on code 44121, instead of billing this on a separate encounter w/ 44120 and modifier 59 & 78?
SuperCoder Answered Fri 07th of February, 2020 05:46:20 AM

Hi Stephanie,

Since, it is the second session due to the complication you have performed the resection, then bill the resection procedure with the modifier 78 (Unplanned Return to the Operating/Procedure Room by the Same Physician or Other Qualified Health Care Professional Following Initial Procedure for a Related Procedure During the Postoperative Period).

Although, add-on code (44121) cannot be billed without out the primary code (44120).

Also, it is necessary to provide the supportive documentation to support the medical necessity for the return to OR. It is suggested to code the complication code also.

On the other hand, modifier 59 (Distinct Procedural Service) would not be appropriate. Modifier 59 can be appended to identify a procedure that is distinct or independent from other non–E/M services that the provider performs on the same day. Whereas, in your case it is unplanned return to OR.

Hope this helps!

Stephanie Posted Fri 07th of February, 2020 11:05:28 AM
Can you please clarify your response. Are you stating I should bill 44121 w/ the 78 modifier?
SuperCoder Answered Mon 10th of February, 2020 03:45:41 AM

Hi Stephanie,

Hope you are keeping well.

CPT 44121 is an add-on code and cannot be billed without the primary code (44120). CPT 44121 cannot be billed until there is additional resection and anastomosis (44121) with the first resection and anastomosis (44120). So, do not append modifier 78 with CPT 44121, because it will not be coded in the second session until there is no additional resection. Bill the resection procedure i.e. 44120 with the modifier 78 (Unplanned Return to the Operating/Procedure Room by the Same Physician or Other Qualified Health Care Professional Following Initial Procedure for a Related Procedure During the Postoperative Period) for the second session. Make sure to add the diagnosis code of complication for the second session of the procedure.

Hope this helps!

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