Explaining Modifier 78 in detail

Introduction

Finding Modifier 78 in your AI Software

If you have iVECoder or a similar but inferior product, you'll want to navigate to the top of your software, click the Code Lists or Search bars. From there choose "modifiers."

Next take a few seconds to see the preceding and proceding modifiers as a teaching moment. You can refresh yourself not just on Modifier 78 but also 76-82.

Modifier 78 Definition

iVECoder gives you all the answers you see in one simple search and click.

Modifier 78 is the unplanned return to the Operating Room/Procedure by the same physician or other qualified health care professional following the initial procedure. If related to the original procedure, use Modifier 78.

Global Period Consideration

Identify if the global period has a 000, 010, 090, YYY, or ZZZ global surgery period by searching the primary procedure in iVECoder.

When Surgery Complications Occur

You can use modifier 78 when a similar or the same procedure must be performed when a complication occurs after the completion of the initial procedure.

INNAPROPRIATE USAGE OF MODIFIER 78

• Surgery is unrelated to the original procedure
• Procedure code does not have global surgery indicator of 000, 010, 090, YYY, or ZZZ on the MFSDB.
• Surgery was performed somewhere else besides the OR.
  

History of Modifier 78

• CMS made modifier 78 effective on 1/1/1984
• Medicaid Effective same date; 1/1/1984
• Specialities included are ASC.
  

Introducing iVECoder: Your Comprehensive Coding Solution

In the ever-evolving landscape of medical billing and coding, staying up-to-date with the latest codes, guidelines, and modifiers is essential for maximizing revenue and preventing compliance issues. This is where iVECoder comes into play.

iVECoder is your all-in-one coding solution, designed to empower practice managers, billing managers, and small clinics with the tools needed to navigate the complex world of medical coding. Here's why you should consider making iVECoder your go-to resource:

Up-to-date Code Lookup

iVECoder offers an extensive and continuously updated code database, ensuring that you always have access to the latest CPT, ICD-10, and HCPCS codes. Say goodbye to outdated coding books and hello to real-time code searching.

Mock Authorization and Adjudications

Our platform allows you to simulate the authorization and adjudication process, helping you identify potential billing issues before submitting claims. This proactive approach can significantly reduce claim denials and delays.

Educational Resources

iVECoder provides educational materials, including articles, videos, and tutorials, to keep you informed about coding changes, compliance updates, and industry best practices. Stay ahead of the curve with our comprehensive resources.

Streamlined Workflow

Simplify your coding workflow with iVECoder's user-friendly interface. Easily search for codes, apply modifiers, and generate accurate claims, all in one place. Say goodbye to manual data entry errors.

Compliant Billing

Ensure that your billing practices are compliant with industry regulations and guidelines. iVECoder's built-in compliance checks and alerts help you avoid costly mistakes and audits.

Contract and RVU Negotiations

Use iVECoder to help you negotiate underpayments based on Medicare Physician fees schedules and more.

Summary of Modifier 78

When using modifier 78 you must look at the place of service of both original and secondary procedures, ensuring both are in the operating room. Secondly, ensure the second procedure is related to the first. Lastly, ensure the global period of the original and second procedure have the appropriate 000, 0190, 090, YYY, or ZZZ on the MFSDB.

Utilizing iVECoder can you help you streamline all of this research, plus it can help you run a mock adjudication of the modifier 78 related claim to ensure it meets both billing and compliance regulations for optimal approval rates.

Will Schmidt joined PCG Software as their Chief Strategy Officer in November 2022. Prior to PCG, Schmidt lead TNH as their Sr. Vice President to become the 7th largest pharmacy in the nation. He then went on to consult with and serve as Interim CEO or Consultant to over 20 different companies specializing in profit strategies, operational efficiencies, vendor relations and partnerships, and exit strategies, include an international Revenue Cycle Management Company.