# Medicare and Modifier 78



## SBrant (Aug 31, 2015)

Novitas has explained their reason for denial of a claim billing for surgical wound debridement due to infection - unplanned return to the operating room during global  is incorrectly coded with modifier 78 as this modifier is for inter-op services only.

We have 11042-78 and 11045-78 with Dx 998.59 and 682.2

So what modifier should I use?  Of course they cannot tell me but the documentation they pointed me to shows modifier 78.  I cannot find any other modifier that fits.

Any suggestions on where I can find this info?


----------



## thomas7331 (Sep 1, 2015)

Perhaps it's an error with the place of service code?  If you're billing for services in the office and using 78 for a return to the O.R., it could conflict and cause a denial in their system.


----------



## SBrant (Sep 2, 2015)

Thank you, thomas7331.  I had not considered that.  We do have a POS of 11 on the 11042 due to a system default.  I will file a corrected claim.  It is a shame Novitas could not identify the problem as being related to POS.


----------



## mitchellde (Sep 2, 2015)

Where was the service performed?  You cannot change the POS unless it truely was performed in a different location such as the hospital outpatient OR.


----------



## jjhamer1 (Sep 3, 2015)

*Modifier 58?*

Most of the time we use: Modifier 58

Many of our returns to the OR are anticipated for debridement of wounds.

Definition:
Modifier 58-Staged or Related Procedure or Service by the Same Physician or Other Qualified Health Care Professional During the Postoperative Period : It may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. This circumstance may be reported by adding modifier 58 to the staged or related procedure. Note: For treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78.


----------

