Part B Insider (Multispecialty) Coding Alert
Keep An Eye On Your Surgeons' Use Of the 78 Modifier
A previous issue of Part B Insider said that carriers have investigated some providers for using the 78 modifier for post-operative complications treated in the office setting (see PBI, Vol. 6, No. 26). Because the 78 modifier states -return to the operating room,- you should use it only when the physician actually returns to the OR.
Coding experts tell PBI they-re not currently aware of any modifier 78 audits, but that doesn't mean you should relax.
It -seems reasonable- that the carriers would look into modifier 78 use, says Dianne Wilkinson, compliance officer and quality manager with MedSouth Healthcare in Dyersburg, TN. -An -unplanned- return to the OR is the only kind of post-op complication Medicare will pay for outside the global,- she notes.
-If I worked in a clinic where there were surgeons, doing hospital procedures, I-d audit 100 percent of my Medicare usages of 78,- Wilkinson adds. -There shouldn't be that many.-
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