Modifer 78

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I have a question regarding the modifier 78. We had a patient that had to returned to the OR unplanned. I know the 78 modifier states that the global period does not start over. This occurred towards the end of the patients global period. The patient came into the office (now out of the global period) and we billed an OV. Insurance is denying stating the patient is still in global due to the 2nd surgery and that the 78 modifier just shows that it was unplanned return. Any guidance would be helpful.
 

dkissel

Networker
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Flint, MI
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I may just make a phone call to the payer in this situation, it could have just been an oversight. Who is the payer?
 

thomas7331

True Blue
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Yes, I agree, you'll need to contact the payer on this, or research their policies. Payer policies do vary on whether or not a new global period begins with a new procedure. Some payers will reduce the payment of the procedure with the 78 modifier to pay just the intraoperative portion since they don't include a new global period, but other payers will allow the full payment but begin a new global period.
 
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