Predictors of neck bleeding after eversion carotid endarterectomy

Abstract

p p t a b t r c r t a After carotid endarterectomy (CEA), an individual may be brought back to the operating room for infection, bleeding, or neurologic deficit in the immediate postoperative period or at a later date for recurrent arterial occlusive disease. This review details the former condition, whereas the latter scenario has been described in a previous CPT Advisor article. If the patient’s original surgery was performed by the same surgeon or a surgeon within the same group, the re-exploration will fall within the 90-day postoperative global period. To report any subsequent procedures within a global period, a modifier must be appended to each non-radiologic CPT code for appropriate reimbursement. Modifier 78 denotes “unplanned return to the operating/ procedure room by the same physician following initial procedure for a related procedure during the postoperative period.” Use of this modifier specifically requires a trip back to the operating room and would not be correct for any intervention done in the office setting. From the physician’s standpoint, the postoperative period begins as soon as the patient leaves the operating room. However, from a billing/coding standpoint, the global period begins on the day following the surgery. The 78 modifier is then potentially appropriate for an additional procedure after CEA that occurs on postoperative day number 1 through 90. Therefore, subsequent procedures on the same day are not yet in the global period and may require the 59 modifier to clarify as separate and distinct from the original CEA. These additional interventions are subject to the multiple procedure payment reduction. CPT code 35800 describes “Exploration for postoperative hemorrhage, thrombosis or infection; neck.” This includes evacuation of a hematoma, direct repair of a bleeding site, inspection of the endarterectomized surface, and exploration for infection with or without drainage. CPT code 35701 (Exploration (not followed by surgical repair), with or without lysis of artery; carotid artery) is never appropriate in this situation. Additionally, CPT code 35201