78 - JE Part B

Return to Operating Room for related surgery during post op period

Instructions

This modifier is appended to another surgical code for an unplanned return trip to the operating room during global post op (10 or 90 days).

Correct Use

• Append 78 modifier in first position as the pricing modifier
  • E.g., Possible complications
• Payment limited to allotted intra-op services only
• Append modifier 58 if return procedure was staged or planned

Incorrect Use

• If Medicare Physician Fee Schedule (MPFS) indicator list marked with "XXX", then no modifier needed as the code has no global dates

Claim Coding Example

• Provider performs bypass on February 24, 2015, and then nine days later, because of a possible infection, an unplanned return trip back to the operating room for a chest wall exploration.

Resource

• CMS Internet Only Manual (IOM), Publication 100-04, Medicare Claims Processing Manual, Chapter 12, Sections 30 and 40.2