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Oncology & Hematology Coding Alert

Vocabulary Tip:

Put a Stop to OR Denials

Published on Mon Jun 20, 2005

Memorize this definition to skip to the head of the coding class Before you report modifier -78, double-check that your procedure took place in an "operating room" (OR) as Medicare understands it:
 
"A place of service specifically equipped and staffed for the sole purpose of performing procedures. The term includes a cardiac catheterization suite, a laser suite, and an endoscopy suite. It does not include a patient's room, a minor treatment room, a recovery room, or an intensive care unit (unless the patient's condition was so critical there would be insufficient time for transportation to an OR)."
 
 - Source: Medicare Carriers Manual, Chapter 4, Section 4821.B, available on the CMS Web site www.cms.hhs.gov/manuals/14_car/3b4820.asp.
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