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Anesthesia Coding Alert

Reader Question:

Compare Charts to Decide on 76 or 78 for Second Surgery

Published on Wed Jan 11, 2012

Question: A patient had a CABG procedure, then had to return to surgery later the same day because of complications. The same anesthesiologist handled both cases. The insurance company is denying our second claim with 00560 and modifier 78 as a duplicate claim. Someone suggested we resubmit with modifier 59 so it will be paid. What should we do? Nebraska SubscriberAnswer: Compare the two operative reports to determine whether the surgeon performed the exact same procedure both times. Understanding what happened during each operative session will help you choose the correct modifier. Use modifier 76 (Repeat procedure or service by same physician) only if the surgeon performed the exact same procedure when they returned to the OR. Modifier 77 (Repeat procedure or service by another physician) doesn't apply in your case because the same anesthesiologist participated in both surgeries. Select modifier 78 (Unplanned return to the operating/procedure room by the [...]
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