Otolaryngology Coding Alert

Question: Should I use modifier -78 or -55 when the otolaryngologist performs debridements in the office following functional endoscopic sinus surgery (FESS)?

Louisiana Subscriber

Answer: Modifier -78 (Return to the operating room for a related procedure during the postoperative period) applies when the patient must be returned to the operating room (OR). FESS procedures have zero globals, so a modifier is not required. However, if a septoplasty was performed, for example, a modifier might be necessary. In this case, the patient was not returned to the OR, so modifier -78 should not be appended.

Modifier -55 (Postoperative management only) also is totally inappropriate here. It is appended by another physician, not the physician who performed the procedure. Further, it should be appended to the original procedure to indicate that the physician performing follow-up should be paid the post-op component of that procedure.

Because only FESS was performed, the post-op period ends the day after the original procedure. Consequently, no modifier is needed because there is no global period. Had a septoplasty or turbinectomy been performed at the same time as the sinus surgery, however, a post-op period (probably 90 days) would be in force.

In such situations, the appropriate debridement code must be appended with a modifier to indicate it is unrelated to the original procedure with the 90-day global and belongs to the FESS (which had zero global days). To do so, append modifier -79 (Unrelated procedure or service by the same physician during the postoperative period) to the debridement code.