Appending modifier 78 to a claim indicates that an unplanned return to the operating room was necessary during the postoperative period of a surgical procedure. In the context of a service provided to a Medicare beneficiary, using this modifier specifies that the additional procedure is related to the original surgery but was performed due to complications or issues that arose postoperatively.
When modifier 78 is applied, it indicates that the service provided fell within the global surgical period of the initial procedure. Therefore, it does not initiate a new global period as would be the case with other modifiers. Instead, the payment for the service associated with modifier 78 is typically limited. Specifically, Medicare pays only the intraoperative percentage of the procedure's allowable fee, reflecting that the service was necessary due to complications encountered during the initial surgery.
This modifier is essential for providers to ensure that they receive appropriate reimbursement for follow-up procedures that are related to the primary surgery. By indicating the need for a return to surgery linked to complications, modifier 78 helps delineate the scope of the original service and entitles the provider to an appropriate level of payment, albeit reduced to the intraoperative amount.