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Modifier 78, what is the definition of "procedure room"?

Catherine Posted Tue 12th of March, 2013 21:54:15 PM

With modifier 78 does the "procedure room" have to be at an ASC or hospital? Can the place of service be 11(office)?

SuperCoder Answered Thu 14th of March, 2013 06:20:41 AM

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.

Check this:
http://www.ophthalmologymanagement.com/articleviewer.aspx?articleID=107567

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