Surgical Coding: Modifiers 58, 78, and 79

SURGICAL MODIFIER CHOICES

Surgery Modifier Choices are Key to Surgery Reimbursement

Surgery modifiers are a powerful tool that can either increase or reduce the value of your services. Either way, these numbers change the definition of the surgery code you’re reporting. So, if you’re not sure of the rules, you’re putting yourself at risk for undercoding and may be hurting your bottom line when it comes to surgical reimbursement.

Surgical Reimbursement: 3 Questions Clinch Your Decision to Apply 78

Modifier 78 is often confused with similar modifiers such as modifier 58 and modifier 79. To ensure you are using the correct surgery modifier, ask yourself three questions. If all the answers are “Yes,” modifier 78 is the one to use.

1. Does the Procedure Fall Within a Global?

When coding for surgery, you would only apply modifier 78 if a subsequent procedure by the same surgeon falls within the global period of an earlier surgery. For instance, modifier 78 might be appropriate for a procedure that occurs on day 30 following a major surgery with a 90-day global period.

1. Is the Procedure ‘Related’ to the Initial Surgery?

In order to achieve appropriate surgical reimbursement, when appending modifier 78, the available documentation and surgery diagnosis must substantiate that the surgeon performed the subsequent procedure due to conditions arising from the initial surgery.

So, to be clear, when coding for surgery, append modifier 78 when coding for the surgeon’s effort to deal with complications such as infection or separate control of bleeding. A complication may be related to the initial procedure, but it...