Gastroenterology Coding Alert

Question: A patient had a basic partial colectomy on May 16, which put his global period ending Aug. 14. On Aug. 10, he returned to the operating room. Should I use modifier 78 or 79?


Louisiana Subscriber

Answer: Modifiers 78 and 79 are both for use on postoperative procedure claims. Choosing the right one depends on the patient's status and whether the service required a return to the operating room or somewhere else, like the physician's office.

Modifier 78 basics: If your physician performs a procedure and then the patient returns to the operating room with complications, modifier 78 (Return to the operating room for a related procedure during the postoperative period) is your choice. The follow-up procedure must be serious enough that your physician performed it in the operating room -- or you can't use modifier 78.

Apply 79 when new circumstances arise: You should use modifier 79 (Unrelated procedure or service by the same physician during the postoperative period) when your physician must undertake the subsequent surgery for conditions unrelated to an initial surgery, and the subsequent surgery occurs during the global period of the patient's initial surgery.

In other words, if the same physician performs a separate evaluation and a distinct, unrelated surgery for a separate condition during the global period of a previous procedure, you should append modifier 79 to the subsequent surgical procedural code(s).

Remember: When you file a claim with modifier 79, a new surgical global period begins.