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Question: Five days after draining a peritonsillar abscess, our otolaryngologist had to drain it a second time. The original service has a 10-day global period, so can we bill for the second procedure and, if so, how do we do that?

Georgia Subscriber

Answer: In this scenario, you may be able to bill 42700 (Incision and drainage abscess; peritonsillar) for a second time within the global period of the first service. However, you will need to append a modifier to the second 42700 claim to tell the payer why you reported the service a second time during the global period. Determining which modifier applies will depend on the documentation, however.

If the physician drained the abscess a second time due to a complication, modifier 78 (Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period) is your most likely option. Keep in mind, however, that to use this modifier, you must return the patient to the operating room (OR). If you don’t, then it is not applicable.

If the physician planned the second procedure or performed it do more extensive drainage, then modifier 58 (Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period) is your best bet. If you use this modifier, you are not required to return the patient to the OR and can perform the procedure in your office.

Bruce Pegg, BA, MA, CPC, CFPC, Managing Editor, AAPC