Modifiers and AV Access Revisions – 78 or 79?

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Question:

We have read conflicting recommendations for which modifier to report with an AV graft revision. Some say use the 79 modifier and some say 78. Which is the correct modifier?

Answer:

Problems that occur with an AV graft in the 90 day global period, stenosis, clots, etc., are complications of the AV graft creation and are therefore best reported with a 78 modifier, related procedure requiring a return to the OR. Modifier 79, unrelated procedure during the global period of another procedure, is not appropriate since issues with an AV graft are directly related to its creation.

The patient may have underlying vascular insufficiency that contributes to the problem, but problems that arise after an AV graft is created are directly related to its placement. If an access had not been created, the problems would not have occurred. Therefore, a revision to repair a problem with a graft or to facilitate graft maturation during the global period should be reported with a 78 modifier.

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