April 11, 2019
I appreciate your patience in answering my questions. I understand the E&M scenarios so let me throw in another type of call coverage relationship. Recently, I returned a patient to the OR for the physician I was covering; the patient had dislocated their hip after a hip arthroplasty. I reported CPT code 27266 without any modifiers; as I now understand the E&M rules I am wondering if I should have modified the code when I reported to the payor.
Thanks for your comments and ensuring you are accurately reporting your call coverage scenarios. CPT code 27266 is defined as “Closed treatment of post hip arthroplasty dislocation; requiring regional or general anesthesia “. You are correct to present this scenario; the answer depends on whether or not the patient is in a global period.
If the patient is in the global period, you will append modifier 78, as the physician you are covering has to append this modifier. Please note: if the patient had been in the global period and the hip dislocation was treated in the ER without anesthesia, the service would not be reportable according to Medicare rules.
If the patient is not in a global period, you may report CPT code 27266 without a global period modifier.
*This response is based on the best information available as of 4/11/19.