Neurosurgery Coding Alert

When you-re filing claims with modifier 78, don't expect to receive the full fee schedule reimbursement amount, says Nancy Reading, RN, BS, CPC, director of educational services for the American Academy of Professional Coders. Procedures billed with modifier 78 include only the service's "intraoperative" portion (no payment is made for pre- and postoperative care) and are generally reimbursed at 65-80 percent of the full fee schedule value, depending on how the fee schedule allocates the presurgical, intraoperative and postsurgical portions of the CPT code's fee. Keep in mind, however, that the payers will not "reset" the global period when you report a procedure with modifier 78. Because the carrier pays the physician only the intraoperative allowance, the global remains from the original surgery. So, if a complication occurs 20 days into a 90-day global period, only 70 global days remain after the return to the operating room.