Medical coding - Modifiers Q & A 2

A patient is seen in the emergency department because of hyperkalemia due to an inadvertent overdose of his potassium medication. Over the course of the next six hours he receives infusions and his potassium is measured three times. What is the appropriate modifier to report with the second and third potassium determinations?

a. Modifier 59, to show that these were not duplicate charges, but indeed separate incidents.
Incorrect answer. Modifier 91 is specific for repeat laboratory tests.

b. No modifier is necessary for repeat laboratory tests, only for repeat surgical procedures.

Incorrect answer. Modifier 91 is specific for repeat laboratory tests.

c. Modifier 91.
Correct answer.

d. Modifier 91 and 59 should be reported for the second and third determinations.

Incorrect answer. Only modifier 91 is necessary, as it is specific for repeat laboratory tests.

A patient who was high on PCP stabbed himself in the chest, causing a pneumothorax. He was seen in the emergency department and Dr. Jones inserted a chest tube. The patient continued under the influence of the PCP and about an hour later, despite soft restraints, managed to free himself and pull out his chest tube. Dr. Jones reinserted the chest tube via a fresh incision. What modifier should be reported on each procedure?

a. Modifier 76, repeat procedure by the same physician, should be reported for each chest tube insertion.
Incorrect answer. Modifier 76 is the appropriate modifier, but it should be appended only to the second procedure. No modifier is needed on the first procedure.

b. Modifier 76 should be reported with the second procedure, no modifier on the first procedure.
Correct answer.

c. Modifier 59 should be reported with the second procedure, no modifier with the first procedure.
Incorrect answer. Modifier 76 is specific for repeat of an identical procedure by the same physician, and should be reported with the second procedure.

d. Either modifier 59 or 76 may be reported on the first and second procedure.
Incorrect answer. Modifier 76 is specific for repeat of an identical procedure by the same physician, and should be reported with the second procedure. Modifier 59 should be used only when a more specific modifier is not available. No modifier should be reported with the first procedure.

5 A patient underwent gallbladder removal by Dr. Pitts on April 1. On April 16, he developed right lower quadrant abdominal pain and evaluation was strongly suggestive of acute appendicitis. Dr. Pitt performed an exploratory laparotomy and appendectomy for an acutely inflamed appendix. What modifier, if any, should be reported with the appendectomy code?

a. No modifier is needed, because the ICD-9-CM diagnosis code and the CPT procedure code clearly identify that this was a procedure not related to the cholecystectomy.
Incorrect answer. Even though the procedure is clearly not related, modifier 79, unrelated procedure or service by the same physician during the postoperative period, should be reported to make the circumstances completely clear to the payer.

b. Modifier 79, unrelated procedure or service by the same physician during the postoperative period, should be reported with the appendectomy code.
Correct answer.

c. Modifier 78, return to the operating room for a related procedure during the postoperative period, should be reported with the appendectomy code.
Incorrect answer. There is nothing to suggest that the acute appendicitis was related to the cholecystectomy. Modifier 79, unrelated procedure or service by the same physician during the postoperative period, should be reported with the appendectomy code.

d. Modifier 58, staged or related procedure or service by the same physician during the postoperative period.
Incorrect answer. This was not a related or stated procedure, but an unrelated procedure for an unrelated diagnosis. Modifier 79, unrelated procedure or service by the same physician during the postoperative period, should be reported with the appendectomy code.

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