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Modifier Coding Alert

Reader Question:

Claim 78 for Unplanned Returns to OR Related to the First Procedure

Question: Two days after a surgery a Medicare patient experienced a profuse trachiotomy bleed related to the surgery and had to go back to the OR for repair. What modifier can I use?

Tennessee Subscriber

Answer: You will use modifier 78 (Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period) in this situation. Medicare will cover the trachiotomy damage repair (31750-31830, Repair procedures on the trachea and bronchi) because the patient has to return to the operating room for a service relating to the first procedure.

If the original procedure did not cause the damage, you use modifier 79 (Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period).

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