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Understanding Modifier 78

  1. #1
    Overland Park, KS
    Exclamation Understanding Modifier 78
    Medical Coding Books
    The CPT definition of modifier 78 states, "Unplanned return to the operating/procedure room by the same physician following inital procedure for a related procedure during the postoperative period."

    CMS gives a great definition of an operating room, but how exactly do you define a procedure room? Would this modifier be applicable to a physician's office? Let's say the patient had surgery done in a physician's office, but it was done in an exam room and not a procedure room, and then we had to do a related procedure again in the exam room. Would this be modifier 78? What exactly defines a procedure room?

    I hope my question is clear here.

    Thanks in advance.
    Dawson Ballard, Jr., CPC, CEMC, CPMA, CCS-P, CPC-P, CRHC, AAPC Fellow

  2. #2
    Default Procedure Room
    This is really infuriating, but I was told that it can not be an exam room, or an intensive care room. It is a room used only for "procedures" like a cath lab. Hope this helps you.

    Lori cpc,ccvtc

  3. #3
    Overland Park, KS
    This is very frustrating. I am not sure that this modifier would even apply in the physician office setting. Thanks so much for the help.
    Dawson Ballard, Jr., CPC, CEMC, CPMA, CCS-P, CPC-P, CRHC, AAPC Fellow

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