Reimbursement Issues Related to Modifier 78

Modifier 78 is defined in CPT as an unplanned return to the operating room (OR) for a related procedure during the postoperative period:  “It may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure).  When this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure.

Use modifier 78 when the second, related procedure is performed by the same physician.  Note that Medicare considers all physicians of the same specialty within the same group practice to be the “same physician”, so modifier 78 would be used when another ophthalmologist in the group performs the second (related) procedure.

This FAQ addresses the following:

  1. How does CPT describe modifier 78?
  2. Would a minor surgery room located in the physician’s office qualify as an operating room for this purpose?
  3. When is modifier 78 used?
  4. Define “related” in the context of using this modifier.
  5. If the diagnosis codes for the first and second procedures are different, should I use modifier 79 instead?
  6. Does the use of modifier 78 have an impact on payment?
  7. How do payments for claims submitted with modifier 78 differ from those with other surgical modifiers, 58 and 79?
  8. Is modifier 78 used on minor surgical procedures?
  9. Please provide an example of the appropriate use of modifier 58.
  10. Please provide an example of the appropriate use of modifier 79.
  11. Is modifier 78 appropriate for repeat laser procedures performed within the global period?

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