Modifier Codes 78 and 79

Modifier code 78

Modifier code 78 represents return to the operating room for a related procedure during the postoperative period.

Example:

A patient has an open reduction of a fracture of the distal end of the femur with the insertion of pins. While still hospitalized, the patient develops a postoperative infection, and it is determined that the patient is experiencing an allergic reaction to the pins. The patient is returned to the operating room to have the pins removed. The second procedure (removal of pins) would be billed with modifier 78.

Plan benefits for both procedures will be paid based on 100 percent of the eligible charge.

Modifier code 79

Modifier code 79 represents an unrelated procedure or service performed during the postoperative period.

Example:

A patient has fallen and broken her ankle. An orthopedic surgeon sets and casts the ankle. Three weeks later, the same patient falls and breaks her wrist. She is treated by the same orthopedic surgeon. The orthopedic surgeon may choose to bill for the second procedure using modifier 79.

Even though the same patient and the same surgeon are involved, if the surgery performed is clearly a different surgery, and it is performed on a different service date, HMSA does not require the use of modifier 79.

Plan benefits for both procedures will be paid based on 100 percent of the eligible charge.

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