01/04/2022

Billing for 28296 with Screw Fixation-Patient returned to OR with Complications (Screw Removed)

Patient had a bunionectomy on 10/29 code 28296 with screw fixation. Next day complication of screw occurred. Pt taken back to OR on 11/1/21. Screw removed, bone paste and a 0.62" k-wire was utilized to stabilize fracture fragment. What is proper coding since 28296 has a 90 day global? Screw was removed(earlier than 90 days) 20680 rt 79, 28485 rt 79 were the procedures performed is this the proper coding . Thanks

Billing with modifier -79 would not be appropriate with the circumstances listed below. Because the fixation and fracture treatment were done as a result of a complication from the hallux valgus correction, modifier -78 would have to be appended to both procedures in order for separate payment to be made. Modifier -79 would be appropriate to be billed if these procedures were performed for a separate issue not related to the initial surgery in October. It is possible that the insurance may request supporting documentation to justify the use of modifier -78 for a return to the OR to justify additional reimbursement for the surgical services. The op-reports should be explicit in outlining that the patient is returning for another major procedure due to complications from the initial hospital encounter from a few weeks prior.