My Modifier Moment- 78

My Modifier Moment- 78

 

 

Modifier 78 is another global modifier used to show a payer why a service in the global period should be reimbursed. 

 

It differs from 58 as it is not used on a planned service or a more extensive service but is used for situations that are unexpected or unusual but are related to the initial surgical service (unlike modifier 79 which is used in unrelated major surgical services during post op care). 

 

Modifier 78 is needed when something unforeseen and unexpected happens due to the initial surgery. 

 

With modifier 78 appended MCR and others will pay approximately 70-80% of the full fee, the portion related only to the intra-operative work (unless a payer tells you differently). 

The global period is not reset so remember to make sure when the global period ends on the initial surgery that you know you are out of the global period even though there was another surgical service. 

For example your patient  has major surgery, then on Day 30 of your post op period they have an unforeseen complication and are taken back to the OR for another major surgery, you append 78 to the surgery to correct the unfirseen complication and your global period now still ends in 60 days. 

Not understanding this can create revenue loss as you may need to capture EM codes if the patient returns 61 days after the second major surgery for a follow up, as you were not paid for any post op care if you appended 78 modifier. (Remember again this is for Medicare but could differ by some private payers, so know your payer guidelines in order to not lose revenue).

 

Here are some examples of modifier 78 usage. 

 

  • Ex 1- A patient develops severe post operative pain and limited range of motion after knee replacement  surgery and is returned to the OR for an arthrotomy to evaluate the components and evacuate a post operative seroma. This was not planned and is not part of the initial surgery. Append 78 modifier.                                                                     
  • Ex 2-A patient develops abdominal  adhesions after a gall bladder removal surgery and returns to the OR for lysis of adhesions that developed around the site of initial surgery. Append 78 modifier. 

 

It is important to understand that modifier 78 is for related procedures by the same physician during the post op period which are unplanned and/or unexpected. 

 

Ask yourself-

 

If the initial surgery had not happened would this surgery still be necessary? If your answer is No then 78 is the correct modifier as your answer shows that these services are related.

 

78 is generally used in complications. 

 

In Ex 1 above had the patient not had the first surgery they would not have developed the post op seroma. 

 

In Ex 2 above if the patient had not had the initial surgery they  would not have developed the post op adhesions. 

 

 

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