Urology Coding Alert

Requirements and reimbursement potential of modifiers -78 and -79 Practices can avoid forfeiting reimbursement dollars by gaining a comprehensive understanding of how global surgical packages work and the CPT codes to use when billing for services (either related or unrelated) during the period following surgery (global period).
 
You use modifiers -78 (Return to the operating room for a related procedure during the postoperative period) and -79 (Unrelated procedure or service by the same physician during the postoperative period) when a physician has to return a patient to the operating room (OR) for procedures during the postoperative period of another surgical procedure. These modifiers also apply when a different physician from the same professional
group, billing under the same tax ID number, treats the patient during the postoperative period. Medicare's Globals: Minor Versus Major Medicare categorizes the CPT surgical codes as "minor" or "major" as a way of defining their global surgical packages. Minor and major global surgical packages differ according to the number of days covered. Medicare's global package for surgical procedures constitutes 0, 10 or 90 days, depending on their assigned category.
 
Minor procedures include those procedures with either a 0- or 10-day global surgical package. Included in the minor surgical package is the visit the day of the procedure (unless it is significant and separately identifiable from the procedure), the procedure, and postoperative care either 0 or 10 days after the surgery to treat the surgical site. Visits for treatment of unrelated conditions are not included and are separately billable.
 
Major procedures have a 90-day global surgical package.  Included in the major surgical package are the preoperative visit (the day of or the day before), the operative procedure, and postoperative care for up to 90 days.
 
If the procedure is considered "minor" and an office visit is rendered on the same day, you can bill an E/M service with modifier -25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service), if you meet the criteria of the modifier. If the office visit service is integral to the procedure - such as a preoperative exam - you can't separately report it, because it is included in the global surgical package.
 
Against this backdrop, take a look at how modifier -78 can help you recover revenue for related services delivered in the global period. Modifier -78: The 'Complications' Modifier Modifier -78 refers to a "related procedure" in its description and applies when the related procedure is to treat complications arising from the initial surgery, rather than from the patient's condition. This is an important distinction that affects both coding accuracy and reimbursement. You should use modifier -78 only on procedure codes for treating [...]