Medicare Compliance & Reimbursement
Consider Pricing for Modifier 78
Question: For a related procedure done during the global period with modifier 78 attached, should we expect 100 percent allowable payment or is it less since it is related to the previous procedure? If it is less, how much is it compared to the actual allowable amount?
Answer: Modifier 78 (Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period) is for an unplanned return to the procedure room during the postoperative period. When reporting modifier 78, you will only receive reimbursement for the surgical portion of the code. You’ll get no payment for the postoperative care as the patient is already in a global postoperative period for the original surgery for which you were or will be reimbursed. The global period will remain related to the initial procedure performed.
Medicare Compliance & Reimbursement
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