October 1, 2020
We have a patient who had knee surgery and required a return to the operating suite for treatment of a complication during the global period. We will bill the second surgery with a modifier 78. My supervisor is saying the aftercare needs to be extended another 90 days because the surgeon had to return the patient to the operating suite for the same anatomic site.
I have always understood that modifier 78 does not restart the global period, but now am questioning myself. Will you please provide guidance?
Thanks for contacting KZA with your inquiry. You are correct! Modifier 78 (Unplanned Return To The Operating/Procedure Room By The Same Physician Or Other Qualified Health Care Professional Following Initial Procedure For A Related Procedure During The Postoperative Period) does not restart the global period, and will be subject to a reduction in reimbursement for the portion of the global period which overlaps with the original surgery.
CMS’s reimbursement formula for a procedure with a modifier 78 does not include payment for post-operative days, thus the global days stay with the original procedure.
I am including an excerpt from a source citation from Novitas (an example Medicare MAC) on this topic; the concept applies to all Medicare claims:
- An operating room (OR) is defined as a place of service specifically equipped and staffed for the sole purpose of performing procedures. The term includes a cardiac catheterization suite, a laser suite, and an endoscopy suite. It does not include a patient’s room, a minor treatment room, a recovery room, or an intensive care unit (unless the patient’s condition was so critical there would be insufficient time for transportation to the OR).
- Modifier 78 allows for the intraoperative percentage only of major or minor procedures (010 or 090 global periods).
- A new postoperative period does not begin when using modifier 78.
- Medicare allows codes with global surgery indicators of XXX and ZZZ in the Medicare Physician Fee Schedule Database separately without modifier 78.
*This response is based on the best information available as of 10/01/20.