Modifier 78

March 25th, 2009 - Codapedia Editor
Categories:   Coding   Modifiers   Specialty Coding   Surgical Billing & Coding  
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Modifier 78 is used to indicate that the physician who performed a surgery which had a 10 or 90 day global period took the patient back to the OR for a related problem, typically, a complication.  Do not use it for staged or related procedures--that is reported using modifier 58.  For unrelated procedures, see modifier 79.

For modifier 78:

  • Appended to the procedure when the return trip is related to first procedure
  • If complication does not require a trip to OR, do not use modifier 78.  CMS defines an operating room as a hospital, cardiac cath suite, ASC, laser suite and/or endoscopy suite
  • Do not use modifier 78 if the CPT® definition says, "subsequent, related or redo.
  • Same physician

Surgical services are defined in the Medicare Fee Schedule as having a pre-operative, intraoperative and postoperative components.  Payment is made only for the intraoperative service when modifier 78 is used.

This is the modifier to use when complications from a surgery require a return trip to the OR, but the same procedure is not repeated.

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