procedure during the post-operative period – Medicare modifier 78

Definition:

• Indicates the return to an operating room for a related procedure during the post-operative period

Appropriate Usage:

• Surgery procedure codes with 010 or 090 global periods on the Medicare Physician Fee Schedule Database
• To report a procedure, related to the original procedure, performed in an operating room* (OR) during the post-operative period
• To treat the patient for complications resulting from the original surgery (Note: The CPT definition for the modifier does not limit its use to treatment for complications)
• Used to identify a return to the OR on the same day as the procedure or during the post-operative period
• When the procedure code used to describe a service for treatment of complications is the same as the procedure code used in the original procedure, modifier 78 is still the correct modifier to use.

Inappropriate Usage:

• For any procedure code other than a surgery with 010 or 090 global periods on the Medicare Physician Fee Schedule Database
• When the surgery is unrelated to the original procedure
• When performed any place other than the Operating Room.*

Facts:

• Modifier 78 Reimbursement is for the intraoperative percentage.
• Modifier 78 does not begin a new post-operative period.