Policy Statement
When an unplanned return to the operating or procedure room is needed during the postoperative global period of a prior procedure, modifier 78 must be appended to the appropriate surgical code(s) to avoid denial of the service per global period policy guidelines and to ensure proper reimbursement.
Modifier 78 must be appended when the return to the operating room is for a procedure that is related to the initial procedure, occurs in the global period of that initial procedure, the provider is the same for both procedures, and the return procedure is assigned global days of MMM, 000, 010, or 090 in the CMS National Physician Fee Schedule Relative Value File.
Modifier 78 is not appropriate for use with a place of service 11 (office).
When a provider reports an eligible procedure with modifier 78 appended, reimbursement will be 75% of the allowable amount.
Additional applicable modifiers may also apply.
Modifier “-79”: Reports an unrelated procedure by the same physician during a postoperative period. The physician may need to indicate that the performance of a procedure or service during a postoperative period was unrelated to the original procedure. A new postoperative period begins when the unrelated procedure is billed.
When an unrelated procedure by the same physician during a postoperative period, modifier 79 must be appended to the appropriate surgical code(s) to avoid denial of the service per global period policy guidelines and to ensure proper reimbursement.
This modifier is used when an unrelated procedure or service, by the same physician, is performed during the postoperative period (10 or 90 day global) of the original procedure. A new post-operative period begins when the unrelated procedure is billed.
Modifier 79 is not applicable to evaluation and management (E/M) services.
Correct Use
- Only on surgical codes with 10 or 90-day global postoperative periods. Append modifier 79 in first position as pricing modifier.
- Not necessarily needing return to operating room.
- Failure to append could result in noncoverage.
Incorrect Use
- When the Medicare Physician Fee Schedule (MPFS) indicator for the procedure is marked with "XXX," no modifier is needed as there are no global dates.
- Procedures performed by a different provider or at a separate clinic, CMS guidelines recommend using modifiers that accurately denote distinct services or providers.
References
Cross References
- Adm 101 - Global Days
- Mod 107 - Modifier 54; Surgical Care Only, Modifier 55; Postoperative Management Only, Modifier 56; Preoperative Management Only
