Otolaryngology Coding Alert

Question: I used modifier 78 for a return trip to the operating room to control bleeding due to complications from a tonsillectomy that the patient had a few days ago. Should I start a new postoperative period after reporting 42825-78?

Florida Subscriber

Answer: No. The complication (42962, Control oropharyngeal hemorrhage, primary or secondary [e.g., post-tonsillectomy]; with secondary surgical intervention) does not reset the global period, which is still linked to the original procedure, the tonsillectomy (42825, Tonsillectomy, primary or secondary; under age 12). You would count the global period for 90 days starting with the tonsillectomy's surgery date.

Clever: You can simply calculate 90 days by counting forward 12 weeks on a calendar and then adding six days. For example, if 42825 was on Monday, count ahead 12 Mondays. Then, adding six days, the 90th day would be the next Sunday. These two dates make up the post-op span date.

Don't expect to receive the full fee schedule reimbursement amount when you-re filing claims with modifier 78 (Unplanned return to the operating/procedure room by the same physician following initial procedure for a related procedure during the postoperative period). Medicare bases payment for treatment of complications billed with modifier 78 on the procedure's intraoperative portion (no payment is made for pre- and postoperative care). Payers generally reimburse a modifier 78 procedure at 65-80 percent of the full fee schedule value.