Modifier 78

Modifier 78 | Unplanned Return to the Operating/Procedure Room

Modifier 78 describes an unplanned return to the operating/procedure room by the same physician or other qualified health care professional the following the initial procedure for a related procedure during the postoperative period. In this article, we will explain modifier 78, including its definition, when to use it, examples, documentation requirements, billing, common mistakes, other related modifiers, and additional tips.

1. What is modifier 78?

Modifier 78 is a CPT modifier used to indicate that a patient has returned to the operating or procedure room for an unplanned procedure related to the initial procedure and requires the same provider to perform it during the postoperative period.

The unplanned procedure may result from a complication caused by the initial procedure, but it is not considered a repeat procedure.

Modifier 78 tells the payer that the provider performed the unplanned procedure within the initial procedure’s global period.

2. When to use modifier 78?

Modifier 78 should be used when a patient requires an unplanned procedure related to the initial procedure and requires the same provider to perform it during the postoperative period. The unplanned procedure may result from a complication caused by the initial procedure, but it is not considered a repeat procedure.

Modifier 78 should not be used when the patient’s condition requiring additional surgery is unrelated to the original surgery, as this warrants appending modifier 79.

3. Description

The official description of modifier 78 is “Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period.”

4. Examples

Examples of procedures that require modifier 78 include a patient who requires an unplanned return to the operating room due to a complication from the initial procedure, such as a patient who requires a second surgery to repair a bleeding vessel after a previous surgery.

Another example is a patient who requires an unplanned return to the operating room due to an infection that developed after the initial procedure.

5. Documentation

Documentation requirements for using modifier 78 include a clear description of the unplanned procedure, the reason for the unplanned procedure, and the relationship between the unplanned procedure and the initial procedure.

The documentation should also include the date of the initial procedure and the date of the unplanned procedure.

It is important to note that the documentation should support modifier 78 and demonstrate that the unplanned procedure was related to the initial procedure and required the same provider to perform it during the postoperative period.

6. Billing

When billing for a procedure that requires modifier 78, the procedure code should be appended with modifier 78. The unplanned procedure is typically reimbursed the same as intraoperative services of the surgical package.

A new global period does not begin for the unplanned related procedure because it is typically from a complication related to the initial procedure.

However, if the provider performs the unplanned related procedure after the global period of the initial procedure, then a new global period starts for the unplanned procedure.

7. Common mistakes

Common mistakes that medical coders make when using modifier 78 include using it for repeat procedures, using it for procedures unrelated to the initial procedure, and failing to provide sufficient documentation to support the use of the modifier.

To avoid these mistakes, it is essential to carefully review the documentation and ensure that the unplanned procedure is related to the initial procedure and requires the same provider to perform it during the postoperative period.

8. Other modifiers related to modifier 78

Other modifiers related to modifier 78 include modifier 76, used when the same provider performs a repeat procedure, and modifier 77, used when a different provider performs a repeat procedure.

9. Tips

When using modifier 78, it is essential to ensure that the documentation supports the use of the modifier and demonstrates the relationship between the unplanned and initial procedures.

Carefully review the documentation to avoid common mistakes, such as using the modifier for repeat procedures or procedures unrelated to the initial procedure.

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