Modifier 78 Location Question

MichelleAKing

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Hello, I'm hoping that someone can help answer a question for me.
Modifier 78 states: "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".
With that being said, I work for a group of general surgeons and quite often our patients are brought back into our office and taken to our patient rooms where an incision and drainage may be performed of a hematoma or a seroma. I have been considering these as "procedure rooms" since we do procedures here at the office and I have been billing these with a -78 modifier. Now I am told that the -78 is used only if the patient is taken back to the hospital operating room.
I would appreciate clarification on this if anyone has any information that they can share.
Thank you in advance.
Michelle King CPC
 

CodingKing

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Place of service 11 doesn't count as return to OR. ASC or Hospital OR would be a return to OR
 

PIKAPINK

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Modifier 78. Modifier 78 is defined by CPT as “unplanned return to the operating/procedure room by the same physician following initial procedure for a related procedure during the post-operative period. When this procedure is related to the first and requires the use of an operating or procedure room, it may be reported by adding modifier 78 to the related procedure.” This is providing care as a complication of the original surgery, not the original condition.


1) The patient must be returned to the O.R. or endoscopy suite to qualify for the 78 modifier. Unlike modifiers 58 and 79, 78 may not be performed anywhere but in the O.R. or the endoscopy suite.

2) The reason for the subsequent surgery is related to the original surgery, meaning that there is a complication of the surgery requiring a return to the O.R. or endoscopy suite.
 

thomas7331

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I agree, a procedure room in a physician office does not qualify as a return to the O.R. and modifier 78 would not be appropriate. An O.R. needs to be in a location that is a facility certified as such for performing procedures, e.g. ASC or hospital outpatient.

From CMS' Global Surgery Fact Sheet: "An OR, for this purpose, is defined as a place of service specifically equipped and staffed for the sole purpose of performing procedures. The term includes a cardiac catheterization suite, a laser suite, and an endoscopy suite. It does not include a patient’s room, a minor treatment room, a recovery room, or an intensive care unit (unless the patient’s condition was so critical there would be insufficient time for transportation to an OR)".
 
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