Medical coding - Modifiers Q & A 3

6. A patient is brought to the emergency department of Community Hospital following a motor vehicle accident. He appears to have an avulsion of the aortic root and is rushed to the operating room where repair is attempted. The patient expires on the operating room table just as the surgery is being completed and before he can be admitted to the hospital. The CPT code for repair of avulsion of the aortic root is designated as an “inpatient only” code under the OPPS. Is there a modifier that the hospital can report to obtain reimbursement for this procedure when performed as an outpatient?

a. No, if an “inpatient only” procedure is performed on an outpatient basis, the hospital cannot obtain reimbursement under any circumstances.

Incorrect answer. Modifier CA may be assigned when a patient expires prior

to admission when an “inpatient only” procedure is performed on an emergency basis.

b. Modifier CA, procedure payable only in the inpatient setting when performed emergently on an outpatient who expires prior to admission, may be appended to the CPT procedure code.

Correct answer.

c. Modifier ST, related to trauma or injury, may appended and a 50% reimbursement will be available to the hospital.

Incorrect answer. Modifier CA may be assigned when a patient expires prior to admission when an “inpatient only” procedure is performed on an emergency basis.

d. Modifier SC, medically necessary service or supply may be appended and a 25% reimbursement will be available to the hospital.

Incorrect answer. Modifier CA may be assigned when a patient expires prior to admission when an “inpatient only” procedure is performed on an emergency basis.

7. A patient undergoes a bunionectomy on the big toe of the right foot. What modifier is appended to report the location of this procedure?

a. No modifier. By definition, bunionectomy is performed on the big toe.

Incorrect answer. Modifier T5, right foot, great toe, is the appropriate modifier.

b. Modifier T5.

Correct answer.

c. Modifier RT.

Incorrect answer. Modifier T5, right foot, great toe, is the appropriate modifier, as it is more specific.

d. Modifier TA.

Incorrect answer. Modifier TA reports the left foot, great toe.

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