Diane Posted Wed 17th of April, 2019 14:44:49 PM
WE have a patient that had a total knee replacement and was doing fine. Patient developed cancer and is currently receiving cancer treatment. His knee that had the replacement started severely swelling, they are thinking it has something to do with the cancer treatment in that his body is trying to reject the foreign body that being the total knee. THe patient has been coming in to have his knee drained as it is grossly swollen with fluid. Sometimes he comes in every 5-7 days or 10-15 days, depending on the swelling. We have been charging 10160 when the knee is drained and if it falls within the post op global period of the previous draining we append modifier -58 as a staged or related procedure. The insurance company has started denying the bills. We have resubmitted some and they have gone back and paid. But I need to know is it accurate for us to append modifier -58 when a procedure is done during a post op period?
SuperCoder Answered Thu 18th of April, 2019 09:31:36 AM
As per above scenario/documentation, we will not consider it as staged procedure rather take it as repeat procedure. So, >it is appropriate to append modifier -76 when the same physician performs a repeated procedure, and assign -77 when another physician completed the repeat procedure. Feel free to ask for any further query.