tci General Surgery Coding Alert - 2008 Issue 12

Reader Questions: Modifier 78 Won't Provide Total Reimbursement

Question: I-ve noticed that when we report procedures with modifier 78, the payer will reduce our fee. Is this appropriate, or should I be appealing these claims? Tennessee Subscriber Answer:When you file claims with modifier 78 (Unplanned return to the operating/procedure room by the same physician following initial procedure for a related procedure during the postoperative period), you shouldn't expect to receive the full fee schedule reimbursement. Procedures billed with modifier 78 include only the "intraoperative" portion of the service (no payment is made for pre- and postoperative care). They are generally reimbursed at 65-80 percent of the full...

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