# Modifier for bring back to O.R  same day



## zona6789@yahoo.com (Jan 24, 2014)

HI  do the anesthesiologists need to use a modifier on their 2nd claim for the same patient/same day of surgery on the bring backs?  Maybe it would be modifier 77 or 78?  and would these mods apply to anesthesia?  

thanks as always,

judith


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## philwilliams (Jan 24, 2014)

Yes, use mod 77 or 78. You can attach these modifiers to anesthesia CPT codes  (00100-01999).
Phil W,  CPC, CANPC


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## twizzle (Jan 25, 2014)

Judith.Ann@cox.net said:


> HI  do the anesthesiologists need to use a modifier on their 2nd claim for the same patient/same day of surgery on the bring backs?  Maybe it would be modifier 77 or 78?  and would these mods apply to anesthesia?
> 
> thanks as always,
> 
> judith



I wouldn't use any modifiers. For a start, modifier 77 is a repeat service by a different provider. It's only a repeat service in that they are having anesthesia provided... the CPT anesthesia code may well be completely different, the anesthesia provider may or may not be the same as for the first surgery, and the times will be different so it cannot be a repeat procedure. A repeat procedure could be a 1 view ankle x-ray taken twice in the same day..modifier 76 or 77 would apply.

Modifier 78 is inappropriate because only the surgery is subject to global rules, not anesthesia.

The start and stop times are going to be different so any payer should realize this is not a duplicate service. That, along with probably a different anesthesia code, should be sufficient to pay both claims.

Anyone agree or disagree?


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## LeslieJ (Jan 30, 2014)

*Modifier for bring back to O.R same day*

Hi,
Agree with wassock to a degree.

Modifiers 77, 78 & 79 are meant for the surgeons who bring the patient back to the OR during the global period.

Anesthesia doesn't really have a global period so these modifiers don't apply.

However, to break out 2nd case from the 1st, we have to tell the insurance companies that it was a different encounter. Without a modifier of some sort, the payers will deny the 2nd set of codes as inclusive to the first - without regard to start/stop times.  Essentially, the claim that hits first will be the claim they'll pay on.  What a pain - you'd think they'd have some way to look at the time, right?

Two modifiers somewhat apply here:  59 or 76.

Medicare Carriers all over the country are now requiring modifier 76 (repeat procedure) on the 2nd anesthesia case vs. modifier 59 if the CPT/ASA codes are the same.  This tells them that it's a repeat anesthesia service at a later part of the day/evening.

Some payers will continue to want modifier 59 - but do remember this is a modifier of last resort.  

Not saying I agree with modifier 76, but just be aware of some of the changing situations out there.

Leslie J


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## zona6789@yahoo.com (Jan 30, 2014)

thank you all for valuable input.

what about the type where the case is d/c after induction anesthesia,  after 30 mins, the patient vomited.

would that case have mod 53 and then no modifier on the subsequent case that day(which would be the 2nd case) that was completed with no issues?


appreciate your assistance!


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