Practice Management Alert

Question: What's the difference between situations in which I-d use modifier 78 and ones in which modifier 79 would be more appropriate?


Florida Subscriber

Answer: Modifiers 78 and 79 are both for use on postoperative procedure claims. Choosing the right one depends on the patient's status and whether the service required a return to the operating room or somewhere else, like the physician's office.

Modifier 78 basics: If your physician performs a procedure and then the patient returns to the operating room with complications, modifier 78 (Return to the operating room for a related procedure during the postoperative period) is the choice. The follow-up procedure must be serious enough that your physician performed it in the operating room--or you can't use modifier 78.
 
Example: A patient undergoes a transurethral resection of an enlarged prostate gland (TURP). Four days after the surgery, the patient experiences heavy bleeding and returns to the OR for surgery to control the bleeding. This is a complication that required a return to the OR for treatment within the global period of the initial procedure.

On the claim, you would:

- report 52214 (Cystourethroscopy, with fulguration [including cryosurgery or laser surgery] of trigone, bladder neck, prostatic fossa, urethra, or periurethral glands) for the service.

- append modifier 78 to 52214 to show that the physician performed the surgery in the OR due to complications stemming from a prior procedure.

Apply 79 when new circumstances arise: Billers should use modifier 79 (Unrelated procedure or service by the same physician during the postoperative period) when:

- your physician must undertake the subsequent surgery for conditions unrelated to an initial surgery, and

- the subsequent surgery occurs during the global period of the patient's initial surgery.

In other words, if the same physician performs a separate evaluation and a distinct, unrelated surgery for a separate condition during the global period of a previous procedure, you should append modifier 79 to the subsequent surgical procedural code(s).

Example: A patient undergoes a transurethral resection of an enlarged prostate gland. Four days later he has an episode of left renal colic secondary to a left ureteral calculus. The physician places a double-J stent within the left ureter and kidney to bypass the obstruction and relieve the pain.

On the claim, you would:

- report 52332 (Cystourethroscopy, with insertion of indwelling ureteral stent [e.g., Gibbons or double-J type]) for the stent placement.

- append modifier 79 to 52332 to indicate an unrelated surgical procedure performed within the 90-day global of the TURP.

Remember: When you file a claim with modifier 79, a new surgical global period begins. After the procedure in the above example, you would observe the global period for 52332.