bundled codes that cant be unbundled with a modifier

What is the best way to bill this? Surgeon performed lap rt colon resection in the morning and then patient had post op bleeding and then he performed open reseciton of the anastomosis same day. I was billing 44205, then 44160 for the second but these are bundled and cant be unbundled. How do I get them to pay for both??


  • Use 78 modifier on the second procedure for unplanned return to the OR for a complication.
  • It may deny, but you will win on appeal proving the separate sessions, separate procedures.
  • If that didn't work, I suggest XE (one of the expanded 59 modifiers) separate encounter, a service that is distinct because it occurred during a separate encounter
  • When this subsequent procedure is related to the first procedure and requires the use of the operating room, this circumstance may be reported by adding the modifier “-78” to the related procedure. 
    Dr Santosh kumar provides medical coding training
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