Wiki Use of Modifier 78 for same day return to OR

[Katyford89]

Question, is it appropriate to use modifier 78 if the unplanned return to OR is the same day as the original procedure? Example:

Progressed well in labor and had a spontaneous VBAC of a living infant. The placenta delivered with gentle traction, but the placenta was noted to be still attached to a solid, muscular mass. I recognized a uterine inversion, with concern for possible abnormal placentation or PAS disorder given hx of one prior cesarean delivery although the placenta was noted to be posterior on US without evidence of accreta. I counseled the pt on need to go to the OR for pain management to attempt to reduce the uterine inversion and possible need for diagnostic laparotomy and hysterectomy. Consents signed. Pitocin was turned off at this point. The placenta was still attached to the uterus.

OP note:

In the OR, the patient was placed in stirrups. Massive transfusion protocol was initiated due to concern for ongoing blood loss. Terbutaline was administered. At this point, the placenta had sheared from the uterus. I examined the placenta, and it appeared intact. It was sent to pathology for evaluation.

I proceeded to manually reduce the uterus until it resumed normal anatomical position. I ensured the cavity was clear of clot and debris. I placed a Bakri balloon and confirmed with US placement at the fundus. I filled the bakri with 290 ml of normal saline. The patient was given pitocin, TXA, methergine and carboprost for the bleeding.

If mod -78 is not appropriate, would mod -51 be appropriate, or any other modifiers? Any advice would be great. Thanks!

 

[mk2001]

Question, is it appropriate to use modifier 78 if the unplanned return to OR is the same day as the original procedure? Example:

Progressed well in labor and had a spontaneous VBAC of a living infant. The placenta delivered with gentle traction, but the placenta was noted to be still attached to a solid, muscular mass. I recognized a uterine inversion, with concern for possible abnormal placentation or PAS disorder given hx of one prior cesarean delivery although the placenta was noted to be posterior on US without evidence of accreta. I counseled the pt on need to go to the OR for pain management to attempt to reduce the uterine inversion and possible need for diagnostic laparotomy and hysterectomy. Consents signed. Pitocin was turned off at this point. The placenta was still attached to the uterus.

OP note:

In the OR, the patient was placed in stirrups. Massive transfusion protocol was initiated due to concern for ongoing blood loss. Terbutaline was administered. At this point, the placenta had sheared from the uterus. I examined the placenta, and it appeared intact. It was sent to pathology for evaluation.

I proceeded to manually reduce the uterus until it resumed normal anatomical position. I ensured the cavity was clear of clot and debris. I placed a Bakri balloon and confirmed with US placement at the fundus. I filled the bakri with 290 ml of normal saline. The patient was given pitocin, TXA, methergine and carboprost for the bleeding.

If mod -78 is not appropriate, would mod -51 be appropriate, or any other modifiers? Any advice would be great. Thanks!

XE modifier for separate encounter on the same day.

 

[csperoni]

While I don't disagree with -XE, I would also use the -78 to indicate it was a return to the OR. Per the CMS global surgery booklet:
Return to OR for Related Procedure During Post-Operative Period
When treatment for post-operative complications requires an OR return trip, bill the CPT code that
describes the procedures during the return trip. If no such code exists, use the unspecified procedure
code in the correct series, 47999 or 64999. Don’t use the procedure code for the original surgery
unless you repeat the identical procedure.
Use the CPT code and report modifier –78 (Unplanned return to the operating or procedure room by
the same physician following the initial related procedure during the post-operative period).
The physician may also perform another procedure during the initial procedure post-operative period.
When this subsequent procedure relates to the first procedure and requires the operating room, bill it
using modifier –78.
NOTE: The CPT modifier –78 definition doesn’t limit its complications treatment use.