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Thread: modifier -78 or corrected claim with -51???

  1. #1
    Join Date
    Apr 2007

    Default modifier -78 or corrected claim with -51???

    AAPC: Back to School
    We have a patient that had a carotid endartectomy and later that day developed a hemorrhage and had to be taken back to the OR and had the wound explored. I billed the exploration w a -78 on a separate claim. However Medicare denied of course because they didnt like the modifier and my ofc mgr is saying we should have filed a corrected claim on our original claim and used a -51 instead of a -78.
    I guess I was thinking that since it was a separate session that warranted a separate claim. Should I be billing this way or if a patient has two different surgeries in one day do they need to be on the same claim??
    Any help would be greatly appreciated!
    Mary Beth Gord, CPC

  2. #2

    Default Billing mod-78 was appropriate

    When a complication occurs on the same day, the mod -78 charge should be billed on the same claim. When billed on separate claims, there is risk of a denial in the event that the "complication" claim gets processed before the first/original procedure. When this occurs, the claims processing system has not picked up the first procedure. Therefore, denying the mod-78 claim as "invalid modifier."

    PTaylor, CPC

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