Wiki Modifier 78 or 79???

[chogan]

We have a patient that had a THA on 9/9/2020, patient then released to nursing home for rehab. Patient then had an un-witnessed fall and sustained a periprosthestic femur fracture and has to have a total revision done of the same hip to replace both components. The question is whether we use modifier 78 (unplanned, related procedure) or 79 (unplanned, unrelated procedure)?

 

[thomas7331]

Since it is a new injury and not a complication that was responsible for the need for the procedure, I would use modifier 79.

Some payer policies may reduce payment for the procedure with modifier 78 to account for the overlap in the global periods in a case where both procedures are for the treatment of the same injury or illness. In a case such as this, I would argue that the new injury justifies a new global period, so it should be considered unrelated.