Charlene Posted Tue 14th of February, 2017 14:29:11 PM
PATIENT IS STATUS POST REVERSE TOTAL SHOULDER. THE GLENOSPHERE BECAME DISASSOCIATED FROM BASE PLATE AND WAS ROTATED. THE EXISTING SCREWS WERE TIGHTENED DOWN WITH TAPPING DOWN OF PLATE. NO HARDWARE WAS REMOVED AND NO NEW HARDWARE WAS PLACED. ANY IDEAS REGARDING CPT?
IF IT IS UNLISTED, ANY THOUGHT AS TO WHAT OTHER CPT I WOULD COMPARE IT TO?
SuperCoder Answered Wed 15th of February, 2017 03:16:26 AM
From the description that you provide, there is no specific CPT procedure listed for screws tightening in shoulder post reverse total shoulder surgery. However, if tightening is done within global days of shoulder surgery then this service will not be paid (that is within 90 days of service) . But if it is done outside global day, we recommend reporting unlisted code. Also you should include a cover letter stating why you are using the unlisted procedure code. This separate report should explain, in simple, straightforward language, exactly what the physician did. Hope it helps.
Charlene Posted Wed 15th of February, 2017 08:20:10 AM
The patient was taken back to the operating room for this procedure, therefore, even if it is performed with in the global period, with the use of modifier 78, it would be paid at about 70% of allowable.
SuperCoder Answered Mon 20th of February, 2017 01:40:35 AM
Modifier -78 refers to "related procedure" in its descriptor. However, modifier -78 applies when the related procedure is caused by conditions arising from the initial surgery, rather than from the patient's condition. This is an important distinction that affects both coding accuracy and reimbursement. Modifier -78 should be used only for complications arising from the original procedure. You are correct as DISASSOCIATED FROM BASE PLATE, will be complication of main procedure. But payment depents of individual payers. Please feel free to ask for any further assistence. Thank you.