Wiki Modifier 78 use

[sivagurulingam]

Hello,

Can any one clarify the below scenario: The provider rendered a 0 day global period on that day and later next week the same provider done another 0 day global period surgery for related condition of the previous procedure. Can we billed without modifier 78 because of 0 day global period of previous surgery or need to billed with modifier 78 for the second procedure?

I have coded with modifier 78 however the payer denied with EOB like billed with inappropriate payment modifier, there is no 0,10,90 days global procedure was billed previously.

Please help me.

 

[balamuruganm]

Hi sivagurulingam,

''For zero day post-operative period procedures, post-operative visits beyond the day of the procedure are notincluded in the payment amount for the surgery. Post-operative visits are separately billable and payable''

REF: http://www.cms.gov/Regulations-and-Guidance/ Guidance/Manuals/downloads/clm104c12.pdf

Regards,
Balamurugan M , CCS ,CPC,COC

 

[jdibble]

Hello,

Can any one clarify the below scenario: The provider rendered a 0 day global period on that day and later next week the same provider done another 0 day global period surgery for related condition of the previous procedure. Can we billed without modifier 78 because of 0 day global period of previous surgery or need to billed with modifier 78 for the second procedure?

I have coded with modifier 78 however the payer denied with EOB like billed with inappropriate payment modifier, there is no 0,10,90 days global procedure was billed previously.

Please help me.

If a procedure has a 0 day global period, that means that anything (another procedure or an E/M visit) performed after the date of the procedure would be billed separately and no modifier would be needed. If there is a 10 day or 90 day global, then that would mean anything done within that specific time frame after the date of the procedure would be considered part of the global period and could not be billed separately, unless a modifier was used to show the reason for the service - i.e. modifier 78 for an unplanned return to the OR for a related procedure, or modifier 24 for an E/M unrelated to the reason for the global procedure.

Hopefully this helps!