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SEPARATE ENCOUNTER ISSUE

Marisela Posted Tue 21st of January, 2020 12:53:25 PM
Physician performed a ureteral stent placement (52332). Later that evening, physician was called back to OR to perform a pelvic exploration (49000) to evaluate for a bladder injury for a procedure already in progress. ("i was called back to reassess the patient in the operating room as there was extensive pelvic abscess and there was a question of a bladder injury.") I was going to bill the 49000 with an XE modifier as it was a separate encounter; however in reviewing the code in question, I notice it carries a 90d global period. How should I proceed with the 52332 to pull it out of global as I am confused now with this specific situation.
SuperCoder Answered Wed 22nd of January, 2020 04:15:17 AM

Hi,

 

When complications from an initial procedure cause your physician to perform a follow-up procedure for a patient, physician may be able to report the follow-up separately.

If the follow-up procedure was serious enough that the physician had to perform it in an operating room (OR) or suite (hospital or ambulatory surgical center), physician may be able to get paid (partially) for it by using modifier 78 (Unplanned return to the operating/procedure room by the same physician following initial procedure for a related procedure during the postoperative period).

In other words: You should append modifier 78 when coding for the physician effort to deal with complications, such as infection or separate control of bleeding. A complication may be related to the initial procedure, but it is not related to the patient's initial condition.

So, it suggested append modifier 78 with CPT 49000.

 

Please also check below link:

https://www.supercoder.com/coding-newsletters/my-ophthalmology-coding-alert/reader-question-or-treated-complication-leads-to-modifier-78-151392-article

 

Hope this helps!

 

Thanks

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