Forum - Questions & Answers

Apr 6th, 2011 - melqura

modifier 78

Can someone tell me how medicare reimburse the surgeon for a surgery code billed with modifier 78?---patient is within the Global period. The First procedure was performed inpatient and the second procedure was at ASC. I am finding that the second proceure will be paid at 70% of the fee schedule, but not sure if that is correct. Thank you

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Apr 7th, 2011 - jschmutz   323 

re: modifier 78

Check with your Medicare carrier. The following information is specific to WPS Medicare.

  • Modifier 78 reimbursement is intra-operative percentage only.

  • Use Modifier 78 to document treatment of complications only.

  • Use Modifier 78 to indicate services furnished in an operating room (OR). OR definition, for this purpose, is a place of service specifically equipped and staffed for the sole purpose of performing procedures. The term includes a cardiac catheterization suite, laser suite, or endoscopy suite. It does not include a patient's room, minor treatment room, recovery room, or intensive care unit.

  • Does not apply to assistant at surgery services

  • Does not apply to Ambulatory Surgical Centers facility fees
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