Wiki Modifer 78

[aracr61]

Needing help with----Modifier 78 does not reset the global period, but Medicare is denying E&M services after initial postop stating postop period resets with second surgery. Is this correct.

 

[mitchellde]

I have always understood it that the second surgery does reset the global.

 

[aracr61]

Thanks Debra,
I will pass that info on.

 

[aaron.lucas]

actually -78 does not reset the global, the modifier that resets the global period is -58, because it's a staged or planned procedure. -78 doesnt reset because it's typically due to complications resulting from the original procedure. not sure who at medicare is saying it resets.

 

[mitchellde]

I just read a bulletin yesterday that stated the 78 does reset the global. I believe it was a CMS bulletin but it could have been AMA. I did not save the link... sorry

 

[aaron.lucas]

maybe that's new for 2012? I remember I went to the AAPC workshop on modifiers last year and the instructor had said 58 resets, but 78 does not, but CMS guidelines coulda changed since then.

 

[ajs]

maybe that's new for 2012? I remember I went to the AAPC workshop on modifiers last year and the instructor had said 58 resets, but 78 does not, but CMS guidelines coulda changed since then.

From what I gathered reading a few different things about modifier 78 - when you use modifier 78 the payer pays only the Intraoperative part of the surgical fee, because there is no pre-operative time period and the post operative time does not reset. If, however, you are using a 58 or 79, those are either staged or unrelated to the original procedure, so the post op time does reset.

Directly from the Medicare Claims Processing Manual:

"5. Return Trips to the Operating Room During the Postoperative Period
When treatment for complications requires a return trip to the operating room, physicians must bill the CPT code that describes the procedure(s) performed during the return trip. If no such code exists, use the unspecified procedure code in the
correct series, i.e., 47999 or 64999. The procedure code for the original surgery is not used except when the identical procedure is repeated.
In addition to the CPT code, physicians use CPT modifier “-78” for these return trips (return to the operating room for a related procedure during a postoperative period.)
The physician may also need to indicate that another procedure was performed during the postoperative period of the initial procedure. When this subsequent procedure is related to the first procedure and requires the use of the operating room, this circumstance may be reported by adding the modifier “-78” to the related procedure.

NOTE: The CPT definition for this modifier does not limit its use to treatment for complications.

6. Staged or Related Procedures
Modifier “-58” was established to facilitate billing of staged or related surgical procedures done during the postoperative period of the first procedure. This modifier is not used to report the treatment of a problem that requires a return to the operating room.
The physician may need to indicate that the performance of a procedure or service during the postoperative period was:
a. Planned prospectively or at the time of the original procedure;
b. More extensive than the original procedure; or
c. For therapy following a diagnostic surgical procedure.
These circumstances may be reported by adding modifier “-58” to the staged procedure.
A new postoperative period begins when the next procedure in the series is billed.

7. Unrelated Procedures or Visits During the Postoperative Period
Two CPT modifiers were established to simplify billing for visits and other procedures which are furnished during the postoperative period of a surgical procedure, but which are not included in the payment for the surgical procedure.
Modifier “-79”: Reports an unrelated procedure by the same physician during a postoperative period. The physician may need to indicate that the performance of a procedure or service during a postoperative period was unrelated to the original procedure.

A new postoperative period begins when the unrelated procedure is billed."