Modifier 78 and 79

Modifier 78 

“Unplanned return to the operating or procedure room by the same physician following initial procedure for a related procedure during the post-operative period 

Modifier 79

“Unrelated procedure or service by the same physician during a post-operative 

Example - Modifier 78 

The Dual chamber Pacemaker (CPT 33208) was implanted on Dec 26th and during the post-operative periods, the patients feel uncomfortable due to pain, hence the provider examined and confirmed the Atrial lead and or Ventricular lead is dislodged, hence provider performed “Repositioning of right atrial or right ventricular lead” on Jan 10th.  

For mentioned above scenarios, the claim must be submitted with modifier 78, since this procedure performed within 90 days. CPT 33215 – 78 

Example - Modifier 79 

The physician may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure.  

Provider performs right toe amputation on May 24, 2015 and a left foot amputation On June 25, 2015, surgery was medically necessary within this 90-day global period 

• 5/24/15 Amputation big toe, RT  28820 TA 
• 6/25/15 Amputation foot, LT  28800 79 

 

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