“The patient initially had a gastroc recession at the right lower extremity. Our surgeon performed a debridement procedure of the right foot ulceration. It was performed in the clinic, and we planned to code it as CPT 11042. However, the patient is in the 90-day post op period from the initial surgery that was performed 4 weeks ago. Is a modifier necessary to submit for payment? Is it 79?”
So, a gastroc recession was performed on the right lower extremity. During the postoperative global period, a right foot ulceration was debrided on the right foot and coded using CPT 11042 which is defined as the following: Debridement, subcutaneous tissue (includes epidermis and dermis, if performed); first 20 sq. cm or less. Since the debridement of the ulceration was performed 4 weeks into the 90-day postoperative global period that was created by the gastroc recession, a modifier would certainly be necessary to append to CPT 11042 in order to be reimbursed.
There are 3 potential modifiers that are used to append to a CPT/procedure code when it is performed and billed within the 90-day postoperative global period that was created by the CPT/procedure code that set the global period.
Modifier 58: 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).
Modifier 78: 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.
Modifier 79: 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.
Based upon the above posted scenario, it appears that the most appropriate modifier to append to CPT 11042 would be the 79 modifier. The correct coding scenario would be the following:
CPT 11042 – 79.
This is my opinion.
Michael G. Warshaw, DPM, CPC
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