Modifier 78 Claims Pay Only “Intra-operative” Values
Anytime you submit a claim with modifier 78 Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period appended, expect only partial reimbursement. That’s because codes submitted with modifier 78 garner payment for the intra-operative portion of the service only. This amount is typically 70-80 percent of the full fee schedule amount, depending on the presurgical, intraoperative, and postsurgical values assigned to the particular CPT® code.
Note, however, that submitting a claim with modifier 78 does not reset the global period from the initial surgery. For example, if a patient returns to the operating room where the same physician addresses a complication on day 30 following the “major” initial surgery, the global period still ends in 60 days (90 day global – 30 days = 60 days remaining).
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