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General Surgery Coding Alert

Reader Question:

Modifier -78 Requires Return to OR

Published on Wed Aug 01, 2001

Question: Please clarify whether modifier -78 can be used only in a hospital. We sometimes perform a procedure in the office, such as an I&D of postoperative seroma, and -- a few days later -- perform another I&D for the same reason, appending modifier -78. Is this correct?

Michigan Subscriber
 
Answer: Modifier -78 (return to the operating room for a related procedure during the postoperative period) should be used only if the patient is returned to the operating room (OR). If the procedure was performed in the office, modifier -78 should not be used, says Kathy Pride, CPC, CCS-P, coding supervisor with Martin Memorial Medical Group in Stuart, Fla. She notes that if the procedure is performed in the office -- or any setting other than the OR -- it is included in the initial procedure's global period.
 
In this instance an earlier procedure was performed: The first incision and drainage (I&D) is for a postoperative seroma. If the seroma had a global period and the first I&D was performed within that time, that I&D would not be payable unless performed in the OR and billed with modifier -78 attached.
 
Even if the original procedure includes zero global days, any additional I&D performed within the first 10 days would be bundled to the first I&D (10140, incision and drainage of hematoma, seroma or fluid collection) because it has a 10-day global period.

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