“My associate doctor recently billed for a hospital outpatient surgery on 08/13:
28005 and 11981.
The antibiotic spacer kept displacing during the post op period, so he went back earlier than expected on 10/2 to do the following, hence the patient is still in the global period from the first procedures:
28755 -- 58, RT -- M10.9
20705 -- 58, RT -- M86.9
11750 -- 79, T5 -- L60.0
Is this coded correctly with regard to modifiers and diagnosis codes? I personally have never done a staged procedure, and I know my billing company probably won't know either, so I figured I'd ask here first before submitting and getting hit with denials.”
So, a patient had hospital outpatient surgery performed on date of service 08/13 on the right foot. The CPT/procedure codes that were billed were the following:
CPT code 28005 defined as the following: Incision, bone cortex (e.g. osteomyelitis or bone abscess), foot
CPT code11981 defined as the following: Insertion, drug-delivery implant (ie. bioresorbable, biodegradable, non-biodegradable).
On 10/2, based upon the fact that the antibiotic spacer kept displacing during the postoperative period, additional surgery needed to be performed. What was billed was the following:
CPT code 28755 defined as the following: (Arthrodesis, great toe; interphalangeal joint) – 58, RT (M10.9)
CPT code 20705 defined as the following: (Removal of drug-delivery device(s), intra-articular (List separately in addition to code for primary procedure) – 58, RT (M86.9)
CPT code 11750 defined as the following: – T5, 79 (L60.0)
The 58 modifier is defined as the following: STAGED OR RELATED SURGICAL PROCEDURE (“STAGED, RELATED, PREPLANNED”). It may be necessary to indicate that the performance of a procedure or service during the postoperative period was planned or anticipated (staged). In order to use the 58 modifier on a subsequent procedure to create a staged, related, pre-planned scenario, the performance of the subsequent procedure must be planned in advance. When the initial procedure set is performed, in this case CPT codes 28005 and 11981, it must be stated within the operative report and within the medical record of the patient on the date of service in question that this is a “staged, related, pre-planned scenario.” This apparently was not the case. The subsequent procedures that were performed, 28755 and 20705, were not planned, but needed to be performed since the antibiotic spacer kept displacing and needed to be removed. This creates a whole different scenario.
The correct modifier that needed to be appended to CPT codes 28755 and 20705 was the 78 modifier which is defined as the following: UNPLANNED RETURN TO THE OPERATING/PROCEDURE ROOM BY THE SAME PHYSICIAN FOLLOWING INITIAL PROCEDURE FOR A RELATED PROCEDURE DURING THE POSTOPERATIVE PERIOD (COMPLICATION MODIFIER). It may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). When this procedure is related to the first and requires the use of an operating or procedure room, it may be reported by adding modifier 78 to the related procedure.
Additionally, the 79 modifier was appended to CPT code 11750. The 79 modifier is defined as the following: UNRELATED PROCEDURE BY THE SAME PHYSICIAN DURING THE POST-OPERATIVE PERIOD. Use when performing an unrelated procedure or service during the post-operative period of another surgical procedure. This was correctly appended.
The correct coding scenario is the following:
28755 – RT, 78
20705 – 59, RT, 78. The 59 modifier needed to be appended to designate a Distinct Procedural Service
11750 – T5, 79
The ICD-10-CM codes that were used are appropriate.
This is my opinion.
Michael G. Warshaw, DPM, CPC
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