Surgical Modifiers: How Do They Impact Reimbursement?

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August 18, 2016

Question:
What reimbursement should we expect when using the global period modifiers 58, 79 and 78?

Answer:
Surgical modifiers are used to indicate that a subsequent procedure was performed during the global period of a prior surgery. Modifiers tell the payer the rationale for allowing payment for this subsequent procedure. The modifiers and reimbursement impact of each is shown below:

Modifier 58: to indicate a second procedure was performed as a staged procedure. Reimbursement should be 100% of the allowable fee.

Modifier 79: To indicate an unrelated procedure was performed during the global period of the original procedure. Reimbursement should be 100% of the allowable fee.

Modifiers 78: To indicate that a complication of an original procedure was treated by a return to the operating room, catheterization or endoscopy suite. Reimbursement should be at 70-80% of the allowable fee. This reduction reimburses for the intra-operative portion of the procedure only, since the patients pre and post-operative services are paid under the original surgery’s flat fee. 

*This response is based on the best information available as of 08/18/16.

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Look for an upcoming KZA Webinar on “Modifiers for surgeons: What you need to know”, which will cover modifiers 22, 59, 58, 79 and 78.

Also stay tuned for another KZA webinar “Surgeon Role Modifiers. Co-surgeon, assistant Surgeon, or coding separate codes: current coding and documentation Guidelines.