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Repeat reduction of prosthetic hip dislocation

Linda Posted Tue 30th of April, 2013 20:09:00 PM

Which modifier should be appended to 27265 when it is done for a second time within the global surgical period of the first reduction? It is done in the ED by different EDMD within the same group. This is a Medicare patient who dislocated the prosethesis while bending over. There is no operating room, per se, but is modifier 78 appropriate?

SuperCoder Answered Wed 01st of May, 2013 20:45:15 PM

Coding Advice: First, because the interpretation of modifier -78 is carrier-specific, check with your local carrier and ask two questions:

1. Will they pay for a related procedure performed in the office during the global period of the total hip joint? (Some may pay only for procedures that require a return to the operating room.)

2. Do they require the -78 modifier to be added to procedures done in the office? (Although the CPT code specifies return to surgery, some carriers prefer -78 to be used to designate an unrelated procedure, whether a return to surgery was necessary or not.)

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