Wiki 78 modifier

seslinger

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will Medicare pay for a procedure billed with a -78 modifier (return to the OR for addt procedure)??

thank you
 
Yes, as long as the procedure is a covered benefit under the Medicare rules and there aren't any other problems with the claim that would cause it to be denied, then it should be paid.
 
so i billed 52235 (paid)
then 52214 -59-78 (denied for "modifier is inconsistent w/ procedure billed")
then 52001-59-78 (denied for "modifier is inconsistent w/ procedure billed")

then i rebilled 2nd and 3rd line without the -59 (& still denying for "modifier is inconsistent w/ procedure billed")

Any ideas ??
 
Modifier 78 is normally used for a return to the OR during the global period, usually on a following day, but it sounds like you're trying to get paid for a return to the OR on the same day? In that case you're hitting the NCCI edits, not the global period. So the modifier 59 should be correct or you could try XE or XU. I'm not sure why the payer is denying it this way. (Are you sure that the modifier 59 is correct on both of these codes? 52001 would bundle to both 52214 and 52235.) But if supported, then those modifiers should not be causing a denial. Have you spoken with the payer to try to get clarification for why this was denied?
 
I am billing 66824- ( Facility only ) POS 24. RR Medicare keeps denying my claims for same reasons (denied for "modifier is inconsistent w/ procedure billed"). Its within their global so I billed. Can someone please guide me on what I am doing incorrectly . The patient is returning to the sx ctr for their second eye cat sx . Should I be using Modifier 78 instead ??

66824-79 RT - denied for "modifier is inconsistent w/ procedure billed"

attempted to removed the RT

66824- 79 - denied for "modifier is inconsistent w/ procedure billed"
 
I am billing 66824- ( Facility only ) POS 24. RR Medicare keeps denying my claims for same reasons (denied for "modifier is inconsistent w/ procedure billed"). Its within their global so I billed. Can someone please guide me on what I am doing incorrectly . The patient is returning to the sx ctr for their second eye cat sx . Should I be using Modifier 78 instead ??

66824-79 RT - denied for "modifier is inconsistent w/ procedure billed"

attempted to removed the RT

66824- 79 - denied for "modifier is inconsistent w/ procedure billed"
OK I responded to your other post but I see here that this is a facility claim you're billing. Facilities are not subject to global periods, so you should not be using modifier 79 - that's a modifier for professional services only.
 
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