Part B Insider (Multispecialty) Coding Alert

Question: Our patient’s hip prosthesis got infected and he presented to the OR in December for treatment by another surgeon (who is not part of our group). Our surgeon then took the patient to surgery yesterday after she had a hip dislocation and he added modifier 78 because she’s in the global period of the December procedure. However, I don’t agree that modifier 78 is necessary since the first surgeon is not in our group or under the same tax ID. Who is correct?

Answer: You are. 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) only applies if the surgeons are from the same group. If you treat the patient during another physician’s global period, that won’t affect you – a new global period will be triggered for the dislocation treatment that will apply to your practice.