Wiki 78,80 modifier usage

[hsmith67]

Patient had surgery by Dr. X. Dr. X was in a practice with several general surgeons and left the practice during global period. Dr. Y was consulted on a Dr. X patient with post op pain, CT showed free air and intussusception. Dr. Y took patient to OR and requested assistance with Dr. Z. Dr. Y billed procedure using mod 78 and claim paid. Dr. Z billed using mod 78 and mod 80. Payor denied for invalid modifier. I assume the issue is mod 78 as Dr. Z has never done surgery on the patient but neither had Dr. Y and Dr. Y's claim paid. Is it appropriate to use mod 78 if the surgeon submitting the claim is NOT the surgeon that performed a surgery within the global period?

 

[daniel]

is the previous surgical CPT 10 days or 90 days global ? And is the new surgical procedure-done within these globals? If so, your application of mod 78 is correct if all providers were of the same group billing under the same #ID. If they aren’t of the same specialty, no need for mod 78.

Note. If only the assistant charge was denied, you may just need to remove 78. Some payors don’t require it ón assist cases.
Plus, if the assistance charge is one denied. Dies your CPT allow mod 80. If not, then you’d have remove this charge.

 

[hsmith67]

The previous was a 90 day global and the surgery was done within the global. 78 was applied to both primary and assistant surgeon claims. Patient has Medicare replacement so I think you are correct - it is payer specific not wanting 78 on the assistant. We will resubmit corrected with 80 only on the assistant case.
Thanks for response!

 

[csperoni]

I also agree with removing -78 on the assistant surgeon claim only. When assisting at surgery, there is no global period.

 

[hsmith67]

Thanks so much for the feedback!