POST OP Hemorrhage Repair

Question:

My coder says I cannot bill for taking the patient back to the OR to repair a post-op hemorrhage during the global period. She says that all complications are included in the payment for the initial surgery. Is that correct?

Answer:

No, that is not the case. You may bill for the post-op hemorrhage repair if you take the patient back to the OR. CPT and Medicare agree that taking the patient back to the OR to treat a complication is billable. Modifier 78 (unplanned return to the OR) is appended to the procedure code(s) performed to treat the hemorrhage. The appropriate ICD-10-CM code for a postoperative hemorrhage would also be reported.