Wiki 78 Modifier

[tiakitty16]

My dad recently had a tonsillectomy and had to go back to the OR 3 days later for a re-cauterization if the incision sites due to extreme bleeding(Unplanned). He received a hospital bill and I was curious to know if they had appended the 78 modifier or not, because I think he shouldn't have gotten a bill since this was in the global period and it was related to the original procedure, and both surgeries were done by the same physician.. Input please?

 

[thomas7331]

Global periods only apply to the surgeon's claims, not to the hospital. Unlike physicians, who are paid a fee for surgeries that includes most routine post-operative care, hospitals are reimbursed based on resource utilization and are not subject to the global surgery rules, and hospitals will bill and expect separate payment for services provided on subsequent days during the post-operative period. So you would not see a 78 modifier on a hospital claim since it is not required; it will only appear on the surgeon's claim. As for the physician's claim, a return to the OR is excluded from the global period under most payer policies, so in this situation a modifier 78 would be appropriate and a separate charge for the second surgery would be eligible for payment for the physician as well as the hospital.

 

[tiakitty16]

He has BCBS, and thank you for better explaining it to me, I'm new to coding(Been coding since November 2017) and didn't fully understand the modifier.