Coding Corner Issue 1
Many procedures have either a 10 or 90-day postoperative global period. Generally, any care provided within that postoperative global period is included in the payment for the procedure, however, there are some exceptions.
If a patient in a postoperative global period experiences a complication of the procedure for which they are in the global period and an evaluation and management (E&M) of that complication is performed, there is no modifier that allows for payment of that E&M. The only E&M modifier than can be used during a postoperative global period is the 24 Modifier which is only appropriate when an E&M service is performed for a problem unrelated to the procedure for which the patient is in the postoperative global period.
If an unplanned procedure which is related to the procedure for which the patient is in the postoperative global period is performed, this may be submitted with the 78 Modifier, only if performed in an operating/procedure room. Procedures related to the problem for which the patient is in a global period may not be submitted unless they are performed in an operating / procedure room. If an unplanned procedure which is not related to the procedure for which the patient is in the postoperative global period is performed, this may be submitted with the 79 modifier, regardless of where the procedure is performed.
The exception to this is the 58 Modifier, which is for procedures performed during the postoperative global period that are planned or anticipated (staged), more extensive than the original procedure, or for therapy following a surgical procedure.
Author: Dr. Jeffrey Lehrman, DPM, FASPS, MAPWCA, CPC is the Orpyx Medical Director. He is a podiatrist, a Certified Professional Coder, and Certified Professional Medical Auditor.
Current Procedural Terminology (CPT®) is copyright 1966, 1970, 1973, 1977, 1981, 1983-2020 by the American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association (AMA). CPT codes and their descriptions do not reflect or guarantee coverage or payment. The existence of a CPT code does not guarantee payment for the service it describes. Coverage and payment policies of governmental and private payers vary from time to time and for different areas of the country. Questions regarding coverage and payment by a payer should be directed to that payer. Orpyx does not claim responsibility for any consequences or liability attributable to the use of any information, guidance, or advice contained in this email. Only providers are responsible for their coding choices.