decisionhealth Newsletters, Answer Books - 2010 Issue 9 (September)
Modifiers -58, -78 and -79 / Medicare pay for services billed with modifier 78
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Article Overview
This article is a billing and coding guidance piece focused on Medicare reimbursement when services occur after an initial procedure and a return to the operating or procedure room is involved. It addresses how postoperative complication-related services are handled, how payment is limited in certain circumstances, and how these issues relate to modifier-based reporting for physicians and coders.
Why This Topic Matters
It helps coders and billing staff understand how Medicare evaluates certain postoperative return procedures and complication-related services so claims can be prepared and reviewed with the correct modifier context.
What You Will Learn
- How Medicare approaches payment for postoperative return-to-procedure-room services
- How complication-related services are described in a modifier-based billing context
- How postoperative payment considerations differ when another physician treats a complication
- General circumstances in which related procedures are discussed during the postoperative period
Who Should Read This
- Medical coders
- Billing staff
- Compliance staff
- Physicians
- Practice managers
Modifiers Discussed
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