Physician billed a 61322 – CPT® Code in category: (Craniectomy or craniotomy, decompressive, with or without duraplasty, for treatment of intracranial hypertension, without evacuation of associated intraparenchymal hematoma)
Shortly thereafter the patient developed an intracranial bleed requiring a return to the OR the same day for a 61313 – CPT® Code in category: (Craniectomy or craniotomy for evacuation of hematoma, supratentorial)
As per coding guidelines these 2 cpt codes cannot be billed together on the same day. Considering the circumstances I advised to bill the charge with a -78 modifier unplanned return to the operating/procedure room by the same physician following initial procedure for a related procedure during the post-operative period and appeal if need be.
Ive been advised to bill 61322 twice with the 76 modifier (Repeat Procedure by Same Physician is used to indicate that a procedure or service was repeated in a separate session on the same day by the same physician) which Im not comfortable in using because the 2nd OP note does not support this code. It does support the bleed CPT 61313.
I’d like others opinions.