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CODING HELP REQUEST: return to hospital (mod 78)

Melanie Posted Tue 23rd of March, 2010 19:50:43 PM

Patient originally had a colonoscopy on 02/12/2010. Upon review of the notes - there were no indications of complications or abnormal issues other than they had polyps removed that required assistance with submuc-injections to do so.

Six days later - the patient returned to the hospital - with bleeding at the sites.

The physician signed off on CPT 45382 and only the diag of 998.11..which would not apply because that would be DURING the procedure and considered inclusive because it would be an act caused by the removal of polyps...

This patient returned 6 days later with bleeding related to the sites where the polyps were removed...

Im new to this area of 'return to OR' - so any info you can share would be great/helpful

SuperCoder Answered Wed 24th of March, 2010 07:39:26 AM

from the query what I can understand is that the original Sx on 02/12/2010 should have been coded with 45381 (colonoscopy + submuc. inj.) and Dx code 211.3 (colon polyps).

The patient returns to OR 6 days later with "bleeding to sites of removed polyps". At this 2nd visit (may be on date 02/18 or 02/19 whatsoever), if the physician performed one more colonoscopy to stop the bleeding, then the Dx would be 998.11 and the CPT is 45382. These two codes (998.11, 45382) are to be used only to bill the 2nd visit (to stop the bleeding). As colonoscopy codes do not have any global days (global period is 0 days, for codes like 45378, 45381, 45382 etc.) you need not use any modifiers like 78. This modifier is to be used only when the return to OR & unplanned Sx is performed within the global period of the original Sx done previously.

Melanie Posted Thu 25th of March, 2010 14:39:49 PM

I thought diag 998.11 was for circumstances that happen DURING a procedure?

SuperCoder Answered Fri 26th of March, 2010 11:28:56 AM

As per the index in the text book the ICD is 998.11 only.

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