# Modifier 78 and 59



## krssy70 (Apr 2, 2015)

I am getting denials for modifier 78 not being billed with modifier 59. 

Example,

Pt has a Lap Chole and returns to ER with abdominal pain a week later. DX of small bowel obstruction.  I bill the small bowlel resection with modifier 78. The surgery gets denied needed additional modifier. They are saying when you bill a 78 you should also bill a 59. I have never billed a 59 with a 78.... 

Is anybody else billing post op complications this way? 

Any input is greatly appreciated. 

thank you


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## jjhamer1 (Apr 2, 2015)

Was the bowel obstruction related to the cholecystectomy? complication of procedure?

If not related, Modifier 79 is the correct modifier:

79 - Unrelated Procedure or Service by the Same Physician or Other Qualified Health Care Professional During the Postoperative Period


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## krssy70 (Apr 2, 2015)

That makes sense. I always thought that when a patient is returned to operating room within global that is the modifier. That is probably why the insurance is looking for an additional modifier. thank you for your help. I will start using 79 in cases like these.


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## krssy70 (Apr 2, 2015)

I have another scenerio to throw out there. I have another one that the patient had an I&D in the office after a surgery becasue the incision is infected. In this case would you use a 78 with 59? the insurance is denying that as well becasue they want the 59 to billed with the 78.


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## cynthiabrown (Apr 2, 2015)

it is my understanding the any procedure in office related to surgery is not billable if within the global, mod 78 requires return to or.   anyone else???


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## krssy70 (Apr 3, 2015)

I disagree Cynthia. If the patient comes back with an infection to the incision wound, that is a billable charge with a modifier and the dx is 998.59. It is above and beyond any global post op visit. I agree that you can't bill an E/M, but you can bill the procedure with the modifier. And the description for mod 78 is operating room/procedure room. I have always been paid for these scenerios in the office. It is just recently that I have been asked by the insurance to add the mod 59. so that is what i was questioning. 

Thank you.


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## cynthiabrown (Apr 3, 2015)

Q.  Is a complication to surgery considered part of the global surgery package? 

A.  All additional medical or surgical services required of the surgeon during the post-operative period of the surgery because of complications, which do not require additional trips to the operating room are considered included in the global surgical package


Medicare includes the following services
in the global surgery payment when they
provide them in addition to the surgery:
? Pre-operative visits after the decision is made to
operate. For major procedures, this includes preoperative
visits the day before the day of surgery.
For minor procedures, this includes pre-operative
visits the day of surgery;
? Intra-operative services that are normally a usual
and necessary part of a surgical procedure;
? All additional medical or surgical services required
of the surgeon during the post-operative period of
the surgery because of complications, which do
not require additional trips to the operating room;
? Follow-up visits during the post-operative period
of the surgery that are related to recovery from
the surgery;
? Post-surgical pain management by the surgeon


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## krssy70 (Apr 3, 2015)

I can see that it states here that a complication such as a wound infection is included in the global surgical package, however I have never been denied by medicare for billing a complication, post op wound infection with an incision and drainage during the global period. This is why i am finding it hard to believe this is correct. And please done take offense for me disagreeing with you. I just have never coded this way. If you could kindly send me the link to where you found this? Im assuming you found this on the web? I would greatly appreciate that, becasue if I am going to change what I have already instructed my surgeons to do in these cases, then I would need something substantial to provide to them. 

thank you


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## cynthiabrown (Apr 3, 2015)

not offended at all. I had questions previous and researched for answers.  This is in medicare learning network global surgery fact sheet. You can probably find the same info in cms policy manual as well.


Cindy


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## krssy70 (Apr 3, 2015)

Ok great.. Looks like I will be doing some reasearch on this. Thank you very much for your input


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