Surgery

“If a Medicare patient is seen in the emergency department and then surgery is performed later that day or night, can the emergency department consult be billed with a modifier -57 along with the surgery? We have been under the impression that, at least in the office, the visit to decide to do the surgery is included in the surgical fee. Are we correct and does this apply to the encounter in the emergency department too?”

“I have a patient who had a hammer toe deformity, and this required repair of the second toe. Unfortunately, the surgical site developed osteomyelitis. This complication occurred at postoperative week number four. I returned to the operating room to perform an amputation of the second toe because of osteomyelitis. I would like to hear thoughts on the appropriate modifiers. And how does the zero-day global period for the amputation play into the billing for the post operative care?”

“Do you have any advice on coding for a return to the operating room within the 90-day postoperative global period for revision of the prior procedures that were performed? The patient had a 1st metatarsocuneiform joint (MTCJ) fusion and 2nd toe, proximal interphalangeal joint (PIPJ) fusion for a hammertoe. Post op x-rays demonstrated excellent fixation and alignment. The patient returned 2 weeks later and had obvious abnormal clinical changes to position of the fusions. X-rays showed loss of position correction at the 1st MTCJ fusion and the 2nd toe fusion as the two-component implant had disengaged and dislocated. The patient didn’t recall any injury. This required a return to the OR for revision of the fusion of both joints done three weeks post operative. The 1st MTCJ plate and screws were removed, the joint realigned and a new plate/screw construct applied. The 2nd toe PIPJ was opened, and the two-component implant re-engaged for alignment correction. Is the following coding scenario 28740 -78, CPT 28285 -78 correct to bill?”

Minor Surgery: Any CPT code that has a Global Period of “0” or “10” days is classified as a Minor Surgical Procedure. Major Surgery: Any CPT code that has a Global Period of “90” days is classified as a Major Surgical Procedure.

“I have a rheumatoid patient with a grossly deformed interphalangeal joint with significant osseous malformations leading to a chronic ingrown toenail on the hallux fibular border. I have ruled out any infection, osteomyelitis, or neoplasm. The bone is grossly hypertrophic and needs excision along with the nail structures on the fibular border. There also may need to be some plastic closure performed. What are the appropriate ICD10 and CPT codes reflective of this scenario?”

“Can anyone please explain the CPT codes for retrocalcaneal surgical treatment? Specifically, the combination of codes that can billed for this pathology. 1. Secondary repair of Achilles tendon 2. Resection of a Haglunds deformity 3. Resection of posterior calcaneal spur.”

“I performed a removal of a failed 1st metatarsophalangeal implant and, at the same setting, an arthrodesis. Should I bill for both the removal of the implant and subsequent fusion?”

“I performed a partial 1st ray amputation that included the hallux and part of the 1st metatarsal. The site did not heal, and a new infection developed at the amputation site. The result is a return to the operating room for a right trans-metatarsal amputation. For the subsequent surgery, I used Modifier 78. After all, this was an unplanned return to the operating room. I evaluated the patient post operatively and I am wondering which date should I be using for the 90-day global period?”

“On February 11, a patient has a transmetatarsal amputation. The patient is a non-compliant, diabetic. The site deteriorates weeks after he leaves the hospital. On March 24, he was readmitted for an infected at the amputation site. On March 26, the remaining 5 metatarsals stumps are removed, and the wound is kept open. How would you recommend coding for the 2nd surgery? What is the code for removing the 5 remaining metatarsal stumps?”

“I am reading conflicting information regarding the dispensing of a post-operative/cast shoe. Medicare never seems to pay for this but commercial carriers usually do. I am reading that this shoe is NOT separately payable when it is dispensed in conjunction with a surgical procedure code. You cannot have the patient sign an ABN and charge the patient for the shoe. Please clarify the dos and don’ts of using the L3260 HCPCS code.”