Reimbursement Advisor

Inserting tandem and ovoids


 

Q Our patient had tandems and ovoids (T&O) inserted by the same physician on April 30 and then again on May 7. Our claim-manager software indicated that we could not bill for both procedures because of the global period. Should we use the modifier -76 (repeat procedure by the same physician) to bill for the second T&O?

A You actually have 2 options in this case. The modifier -58 would be the modifier of choice if the second T&O insertion was planned at the time of the first insertion, i.e., a staged procedure. On the other hand, if the physician decided on a second insertion at some point after the first insertion, the modifier -76 would be the better code.

This article was written by Melanie Witt, RN, CPC, MA, former program manager in the Department of Coding and Nomenclature at ACOG. She is now an independent coding and documentation consultant. Her comments reflect the most commonly accepted interpretations of CPT-4 and ICD-9CM coding. When in doubt on a coding or billing matter, check with your individual payer.

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