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78 Modifier for ASC's

  1. Default 78 Modifier for ASC's
    Medical Coding Books
    I was told today by a Medicare rep that as an ASC, we cannot use modifier 78 for an unplanned return to OR . Has anyone else run into this?

  2. #2
    From SuperCoder Bolt:

    Question 2: Do You Need Modifiers 78, 79?

    I code for an ASC, and my payer won’t reimburse me for claims with modifiers 78 (Return to the operating room for a related procedure during the postoperative period) and/or 79 (Unrelated procedure or service by the same physician during the postoperative period) appended to them. Should we appeal?

    Answer 2: The ASC’s global period for all procedures performed in the facility is 24 hours. Most of the procedures performed in ASCs have a global period of 10 or 90 days, but that global period applies to the operating physician’s claims — not the facility’s claims.

    Therefore, ASC coders will rarely need to use modifiers 78 or 79. One of the unusual cases when you’d use these modifiers would be if a patient underwent a procedure in the ASC and went home to rest. While recovering that afternoon, the patient started to hemorrhage and called thesurgeon.

    The surgeon returned the patient to the OR to stop the hemorrhage. If the patient went back into the OR at the same ASC for a procedure thefollowing day and it was past 24 hours since the ending of the first procedure performed the day before, the ASC does not need to appendmodifiers 78 or 79 to their claim.

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