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

  1. #1
    Default modifier -78 or corrected claim with -51???
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    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. 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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