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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One Response to “Modifier 78 Claims Pay Only “Intra-operative” Values”

  1. Lulu says:

    What about modifier 78 on Anesthesia claims? We use them on our claims when a patient has a postsurgical complication on the same day. I’ve heard we should be using it but then I’ve also heard it is only for Surgical billing not anesthesia billing.

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