Modifier 78 - Now that modifier 78 description

mmelcam

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Now that modifier 78 description has changed to read... Unplanned return to the operating/procedure room by the same physician following initial procedure for a related procedure during the postoperative period, does anyone know if we can use this modifier when a patient comes into the office after a surgery and has a complication (such as a seroma) and we take the patient to our procedure room in our office and perform another procedure (such as i&d of a seroma)?
 

codegirl0422

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I would think it is still part of the postoperative period. Same guidelines as previously. I think procedure room was added for those practices that do procedures in their own procedure rooms (ex. ASC) and there is complications and they are brought back to their procedure room to treat, so those procedures may be able to be billed. Before to use 78, it had to be the OR. The only modifier close to it was 58 and it's for planned/staged procedures. Medicare has listed what they consider complications that are part of the global period.

Now that modifier 78 description has changed to read... Unplanned return to the operating/procedure room by the same physician following initial procedure for a related procedure during the postoperative period, does anyone know if we can use this modifier when a patient comes into the office after a surgery and has a complication (such as a seroma) and we take the patient to our procedure room in our office and perform another procedure (such as i&d of a seroma)?
 

mmelcam

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We acutally have a surgical suite set up in our practice where we do some procedures/surgeries (biopsy, lesion removal, i&d). If the patient was seen in the exam room first then the physician decided to take the patient into the surgical suite to perform an i&d of the seroma during the postop period, can you use a 78 in this scenario?
 

codegirl0422

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Could it be done in the office/exam room?

If not, then I would think you should be able to use mod 78

If it could be done in the exam room, then I would think, no, part of post op. But I have not read alot about the new useage of this modifier.
 

snoprean

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Procedure room requirements

Does anyone know what requirements need to be met to designate a room as a procedure room? We treat burn patients and take them to a separate room to wash out their wounds and debride. Would 78 be appropriate to use if this was not part of a staged procedure?
 

ajs

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Does anyone know what requirements need to be met to designate a room as a procedure room? We treat burn patients and take them to a separate room to wash out their wounds and debride. Would 78 be appropriate to use if this was not part of a staged procedure?
I believe a procedure room has to have a set up like a mini surgical suite. It should be designated for use for procedures only and not be used as a regular exam room. Each state may have specific regulations for certifying a "procedure room" in a physician office. Check with your state department of health on this.
 

Lujanwj

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Below is an excerpt from CMS Claims manual Cpt 12. It doesn't fully explain what you are looking for but gives a little insight into what CMS considers a "Procedure Room". I see a lot of coders mistake a minor treatment room for a Procedure room. Most treatment rooms don't require separate staffing and usually don't have the essential equipment to qualify for a procedure room. I believe the equipment would be "life saving" type equipment in case a complication happens. I'm pretty sure it will need to be certified as stated above. Definitely check your state requirements (Had this open when above replied).

**Treatment for postoperative complications which requires a return trip to the operating room (OR). 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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