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Modifier 78

Cassandra Posted Fri 22nd of January, 2010 19:50:26 PM

Can someone please help. I never had a problem with this modifier until recently. Anyway, I always thought it was used for "return to OR". Was told today that it oould be coded with office procedures also because it states "procedure room" too...

Confused Casey : )

SuperCoder Answered Mon 25th of January, 2010 15:04:14 PM

I think the term "procedure room" was added to the definition of modifier 78 for those practices that conduct various surgeries (not major) in their own designated procedure room within office setting. The revision of the modifier 78 descriptor came probably in 2008. Before this, it had to a "return to OR". Originally, the Medicare carrier manual states that the related service must be performed in a formal OR and defines an OR as --
"An OR for this purpose is defined as a place of service specifically equipped and staffed for the sole purpose of performing procedures. The term includes a cardiac catheterization suite, a laser suite, or an endoscopy suite. It does not include a patient’s room, a minor treatment room, a recovery room, or an intensive care unit."
But now it agrees with the revised CPT definition that the service could be preformed either in the OR or in a dedicated procedure room (though it is not very clear whether that room could be within an office setting). I would prefer the following approach:
If you are performing a procedure to treat a complication by related procedure during the global period, in the office setting, or in OR, or in dedicated procedure room (like an Endoscopic suite), bill the procedure with modifier 78 appended. If denied, appeal with appropriate supporting documentation. However this will vary depending upon carrier and payer.

Melissa Answered Tue 26th of January, 2010 14:55:11 PM

Would it be beneficial for a Primary Care office to have a room designated as a procedure room? My physician does several procedures a day. Is the payment better when a 78 modifier is appended?

Thanks
Missy

SuperCoder Answered Wed 27th of January, 2010 11:09:10 AM

The modified description of the 78 modifier now includes the wprd "procedure room", along with the OR. Probably now you can bill a related Sx, performed in a dedicated room in physician office setting, within the global period of the main Sx.

As per the definition of OR in Medicare carrier manual -- "An OR for this purpose is defined as a place of service specifically equipped and staffed for the sole purpose of performing procedures. The term includes a cardiac catheterization suite, a laser suite, or an endoscopy suite. It does not include a patient’s room, a minor treatment room, a recovery room, or an intensive care unit."

Though it is still not very clear whether a dedicated room in an office will really fetch you more payment for usage of mod. 78, but it can be beneficial to have that kind of room (a "dedicated" one, like an endoscopic suite, laser suite, cardiac cath suite etc.) inside the office setting. But however the payment decision will depend upon the carrier (with private carriers, there is more chance of payment!).

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