Modifier 78: Unplanned return to operating room
CPT defines Modifier 78 as “an unplanned return to the operating/procedure room by the same physician following the initial process for a related procedure during the postoperative period.” When this process is related to the first and necessitates using an operating or procedure room, add modifier 78 to the related procedure.” That is care provided due to the original surgery, not due to the original condition. The idea is to use modifier 78 for a related procedure that wasn’t scheduled ahead of time. A biopsy is performed by a surgeon, for example. The wound becomes infected, necessitating a second procedure to remove the infection.
Modifier 78 comes with the disclaimer:
To be eligible for the 78 modifiers, the patient must be returned to the operating room or endoscopy suite. Unlike modifiers 58 and 79, modifier 78 may only be performed in the operating room or the endoscopy suite.
- To recognize a related procedure (with a global surgery period of 10 or 90 days) that necessitates a return trip to the operating room during the postoperative period of major or minor surgery.
- To care for the patient’s health problems from the initial surgery.
When the procedure code identifies a service for complications, treatment is the same as the procedure code used in the following process.
- On any procedure code with a global period other than 0010 or 0090.
- When surgery is performed, that is unrelated to the original procedure.
- On procedures carried out in locations other than the operating room.
Procedure codes with a global day count of 10 or 90 on the Medicare Physician Fee Schedule Database (MPFSDB) are paid at the intra-operative percentage shown on the MPFSDB. The fee schedule amount for the process is magnified by the percentage and rounded to the nearest.
Procedure codes with no global days on the MPFSDB are compensated at the full fee schedule rate.
Modifier 78: Basic Guidelines
- Submit this modifier to imply that another process was conducted during the beginning procedure’s postoperative period (unplanned process following original protocol) when the successive procedure is connected to the first and necessitates using a functioning or procedure room.
- This modifier can only be used in conjunction with surgery codes.
- For this reason, a functioning room is considered a place of service that is particularly equipped and staffed to perform processes. A cardiac catheterization suite, a laser suite, and an endoscopy suite are all included in the word. That does not include a patient’s room, a minor treatment room, a recovery room, or intensive care unless the patient’s condition is so critical that transportation to an operating room would be unsatisfactory.
- The claim does not require any additional paperwork. Documentation supporting the patient’s claim must be kept in the patient’s medical record. The documentation must prove that the surgeries are linked and that the successive surgery necessitated a return to the operating room.
- Refer to CPT modifier 79 if the successive surgery is unconnected to the initial surgery and is conducted by the same surgeon.
- Suppose the successive surgery is connected to the initial surgery but does not necessitate a return to the operating room and is conducted by the same surgeon. In that case, it cannot be forwarded separately. The initial surgery fee includes extra related surgical procedures that do not necessitate a return to the operating room.
- E/M services performed on the same day as a process with 0 or 10 global days are typically not billed individually from the process.
- E/M services are generally not billed on the day of the processor during the 10-day postoperative period.
If a (subsequent) bilateral process necessitates a return to the operating room after the initial surgery, the Bilateral Indicator in the MPFSDB is 1, or if CPT modifier 50 is not submitted. CPT modifiers 50 and 78 cannot be used to describe the same service. Instead, request the surgery set of rules with CPT modifier 78 and HCPCS modifier RT on one detail line and the same surgery procedure code with CPT modifier 78 and HCPCS modifier LT on another.
An open reduction of a rupture of the proximal end of the femur with the insertion of pins is performed on a patient. While still in the hospital, the patient may develop a postoperative infection, and it is decided that the patient is sensitive to the pins. The patient is taken back to the operating room to remove the pins. Modifier 78 would be applied to the second procedure (pin removal).
Cataracts are removed from both of a patient’s eyes by a physician. The right eye’s vision rapidly returns to normal. The view in the left eye, on the other hand, necessitates a YAG laser capsulotomy. Modifier 78 is employed. The same physician followed the second process during the postoperative period.
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