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Billing for postoperative complication while patient still in O.R.

Natalie Posted Thu 16th of May, 2013 17:54:31 PM

My surgeon performed a cervical lymphadenectomy (modified radical neck dissection) CPT code 38724. After the procedure was completed and the patient was still in the surgical suite and awakened from anesthesia, a hemorrhage of the neck ocurred. The surgeon is telling me to bill for this hemorrhage separately with a modifier -78. However, I explained to him that because the patient was still in the operating room when this happened, it is considered a part of the original procedure. He insists it can be billed. I tried to explain that ONLY if the patient had left the operating room (e.g.-in recovery or back on the hospital floor) can CPT code 35800-78 be billed and paid. Can you please let me know who is correct in this instance? Thank you for your help!

Barbara M. Googe
Billing Manager
Head and Neck Surgeons of New Mexico

Natalie Posted Thu 16th of May, 2013 17:54:51 PM


SuperCoder Answered Thu 16th of May, 2013 22:23:05 PM

Code 35800 differs from other excision or repair codes because it takes place in the circulatory system. This means the physician is concerned with managing a hemorrhage via the blood vessels, rather than by exploring the source of the bleeding.
You should use codes 35800–35860 when your physician has to return the patient to the operating room for exploration for postoperative hemorrhage. That means you cannot use these codes for bleeding that occurs during the initial operative session. According to CCI edits, this code carries a "1" modifier when reported with some codes. This means a bundle with 35800 and one of the approved codes may be broken to append a modifier, with supporting documentation. Check the latest CCI edits for more.
You may need to attach modifier 78 to 35800 to indicate that the service represents a return to the operating room for a related procedure during the postoperative period.

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