Code for back to back surgery

[ChasingSunsets]

I got a situation that has me scratching my head a bit. My friend's doc pulled the trigger and did an ESWL on a patient back on March 17th, 2025.

But wouldn't you know it, the same day, the patient hit the ER because they couldn't pee.

So, the same doc who did the deed admitted him for pain control, and then, get this, went back to the well the very next day and did the exact same ESWL on the patient's same kidney! It's like déjà vu all over again.

Now my friend is trying to untangle this knot and figure out how to properly code all this.

Probably people here know what's the straight answers on how to code that first surgery on 03/17, the consult the doc probably did in the ER before admitting him, and then that second, carbon copy surgery on 03/18.

It feels like we're in uncharted territory here, so any coding wisdom you can throw my way would be a lifesaver.

 

[strandedwolf54]

I got a situation that has me scratching my head a bit. My friend's doc pulled the trigger and did an ESWL on a patient back on March 17th, 2025.

But wouldn't you know it, the same day, the patient hit the ER because they couldn't pee.

So, the same doc who did the deed admitted him for pain control, and then, get this, went back to the well the very next day and did the exact same ESWL on the patient's same kidney! It's like déjà vu all over again.

Now my friend is trying to untangle this knot and figure out how to properly code all this.

Probably people here know what's the straight answers on how to code that first surgery on 03/17, the consult the doc probably did in the ER before admitting him, and then that second, carbon copy surgery on 03/18.

It feels like we're in uncharted territory here, so any coding wisdom you can throw my way would be a lifesaver.

Oh boy that is a tough nut to crack. For that second ESWL your friend probably needs to check out modifier 78 and carefully document the medical necessity for the ER visit and admit during the global period.

 

[HAYABUSA]

I got a situation that has me scratching my head a bit. My friend's doc pulled the trigger and did an ESWL on a patient back on March 17th, 2025.

But wouldn't you know it, the same day, the patient hit the ER because they couldn't pee.

So, the same doc who did the deed admitted him for pain control, and then, get this, went back to the well the very next day and did the exact same ESWL on the patient's same kidney! It's like déjà vu all over again.

Now my friend is trying to untangle this knot and figure out how to properly code all this.

Probably people here know what's the straight answers on how to code that first surgery on 03/17, the consult the doc probably did in the ER before admitting him, and then that second, carbon copy surgery on 03/18.

It feels like we're in uncharted territory here, so any coding wisdom you can throw my way would be a lifesaver.

Double-zap on the same kidney? For coding, sounds like 50590 for the first ESWL on 3/17, then an inpatient consult (maybe 9922x series) if documented right. The 3/18 repeat might need a modifier like -76 for repeat procedure by the same doctor. Be careful tho.

 

[MedCodeNinja]

Totally get that,double zaps can be a pain. The -76 works for the repeat, but have any payers been pushing back on that modifier for ESWL recently? I'm interested to hear how strict they've been with you

 

[Billie.F]

That's a messy case for sure, first ESWL is straightforward, but things get murky fast after the first ER visit and if the doc saw the patient in the ER and made the call to admit, that should be billable as long as it's clearly documented, the repeat ESWL the next day, since it's on the same kidney, you'll probably need to use a modifier to show it was intentional and necessary, not a mistake

 

[ClaimWizard]

Good points! I agree that modifier 78 and -76 are the way to go. I'm curious if payers are being extra picky these days. It seems like having clear documentation is key.

 

[revenuecyclepro25]

Okay, sounds like a tough one. It reminds me of when I was coding a repeat thing during a global period. The key was having all the paperwork to show why it was needed. Modifiers like 78 and -76 can help, but insurance folks are tough. Having clear notes and reasons can really help in these cases. Hope your friend does great