Wiki Medicare and Modifier 78

[SBrant]

Novitas has explained their reason for denial of a claim billing for surgical wound debridement due to infection - unplanned return to the operating room during global is incorrectly coded with modifier 78 as this modifier is for inter-op services only.

We have 11042-78 and 11045-78 with Dx 998.59 and 682.2

So what modifier should I use? Of course they cannot tell me but the documentation they pointed me to shows modifier 78. I cannot find any other modifier that fits.

Any suggestions on where I can find this info?

 

[thomas7331]

Perhaps it's an error with the place of service code? If you're billing for services in the office and using 78 for a return to the O.R., it could conflict and cause a denial in their system.

 

[SBrant]

Thank you, thomas7331. I had not considered that. We do have a POS of 11 on the 11042 due to a system default. I will file a corrected claim. It is a shame Novitas could not identify the problem as being related to POS.

 

[mitchellde]

Where was the service performed? You cannot change the POS unless it truely was performed in a different location such as the hospital outpatient OR.

 

[jjhamer1]

Modifier 58?

Most of the time we use: Modifier 58

Many of our returns to the OR are anticipated for debridement of wounds.

Definition:
Modifier 58-Staged or Related Procedure or Service by the Same Physician or Other Qualified Health Care Professional During the Postoperative Period : It may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. This circumstance may be reported by adding modifier 58 to the staged or related procedure. Note: For treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78.