CCO Admin asked:
If a patient had a bypass of femoral- anterior tibial and then 2 days later had to have an amputation of that same leg. Would you use the modifier 78?
Answer:
### Definition
* Unplanned return to the operating room by the same physician following initial procedure for a related procedure during the postoperative period.
### Appropriate Usage
* To identify a related procedure (that has a 000; 010; 090; YYY; or ZZZ global surgery indicator on the Medicare Fee Schedule Database [MFSDB]) requiring a return trip to the operating room* (OR) on the same day as or within the postoperative period of a major or minor surgery.
* To treat the patient for complications resulting from the original surgery (Note: The CPT definition for the modifier does not limit its use to treatment for complications).
* When the procedure code used to describe a service for treatment of complications is the same as the procedure code used in the original procedure; [modifier 78](http://www.findacode.com/code.php?set=CPTMOD&c=78) is still the correct modifier to use.
### Inappropriate Usage
* On any procedure code that does not have a global surgery indicator of 000; 010; 090; YYY or ZZZ on the MFSDB.
* When the surgery is unrelated to the original procedure.
* On procedures performed in any place other than the OR.
### Facts
* [Modifier 78](http://www.findacode.com/code.php?set=CPTMOD&c=78) allows for the intraoperative percentage only of major or minor procedures (010 or 090 global surgery indicators).
* A new postoperative period does not begin when using [modifier 78](http://www.findacode.com/code.php?set=CPTMOD&c=78).
* Medicare allows codes with a global surgery indicator of XXX in the MPFSDB separately without [modifier 78](http://www.findacode.com/code.php?set=CPTMOD&c=78).
* Medicare allows the lower of either 100% of the fee schedule or the billed amount for codes with a global surgery indicator of 000.
*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 patients room; a minor treatment room; a recovery room; or an intensive care unit.
[Modifier 78 Fact Sheet](https://www.wpsgha.com/wps/portal/mac/site/claims/guides-and-resources/modifier-78/!ut/p/z1/tVRdb5swFP0rfeHRss2XncekWkuzsE37aAgvk8GGeArGNU6y5tfXbJP2FSBqVR5AvrrnHF-dc4E5zGCu2EHWzMpWsZ07b_L464ckiRNM0eq9nyI0T2_ugzd0taAfMbyHOcxLZbXdws1Rd1dlq6xQ9kqoeie7rYdsq2UJSlcTxkPljsmm81C9l1x0gCkOjOjavSmFqzYtl5UUBhDa8-pScrgpCAl4EQUAEVaAkLkXRXEMAh7PMIn9uGQUrkcuuiRhBPPxOdZTg_Z4NPDM0Sg-QLfBZfojAhP45UjDj_mdk_Lbw0M-d3b1Fn23MDvr17ZthIe0MF2fAHkSHPSlnsA36XVaO1-Y3QKpqhZm__eN3WRxl4YDREocf8ZhrzmzooOZjzABCKMIaNMeXFwMEH3X5aP8HT1rmFRS1R76V8tDg1rrPocTzk5lY-O8JYPevHXmH6Q4wi-qNY3buU-_o-_HRSV4OQOcxT4Ii8oHhY8xCKOQRoLMBMUzmEwqkBcqjNEvKAmH6S_a3Ql6_Lr05IX0y6nVfGZcL_9Tnl-ocziY_YnTTUODRyklyIvH4LRKdgednBbvwO11QY-fq-bXZ027-RMs8m25/dz/d5/L2dBISEvZ0FBIS9nQSEh/)
**References:**
* [WPS - Government Health Administrators](https://www.wpsgha.com/wps/portal/mac/site/home/personalized-home/!ut/p/z1/tZNLc9sgFIX_SjZeMjwkG7S0M21U12o7fcSyNh0kQKZjAUGy3fjXByVddNpKapopGwbE-e7VnHNhAXNYGH7SNe-0NfwQzrti8fVDmi5SzNDmPckQWmavb6NXbLOm8)
* [https://www.findacode.com/code.php?set=CPTMOD&c=78](https://www.findacode.com/code.php?set=CPTMOD&c=78) https://www.findacode.com/code.php?set=CPTMOD&c=78
If a patient had a bypass of femoral- anterior tibial and then 2 days later had to have an amputation of that same leg. Would you use the modifier 78?
Answer:
### Definition
* Unplanned return to the operating room by the same physician following initial procedure for a related procedure during the postoperative period.
### Appropriate Usage
* To identify a related procedure (that has a 000; 010; 090; YYY; or ZZZ global surgery indicator on the Medicare Fee Schedule Database [MFSDB]) requiring a return trip to the operating room* (OR) on the same day as or within the postoperative period of a major or minor surgery.
* To treat the patient for complications resulting from the original surgery (Note: The CPT definition for the modifier does not limit its use to treatment for complications).
* When the procedure code used to describe a service for treatment of complications is the same as the procedure code used in the original procedure; [modifier 78](http://www.findacode.com/code.php?set=CPTMOD&c=78) is still the correct modifier to use.
### Inappropriate Usage
* On any procedure code that does not have a global surgery indicator of 000; 010; 090; YYY or ZZZ on the MFSDB.
* When the surgery is unrelated to the original procedure.
* On procedures performed in any place other than the OR.
### Facts
* [Modifier 78](http://www.findacode.com/code.php?set=CPTMOD&c=78) allows for the intraoperative percentage only of major or minor procedures (010 or 090 global surgery indicators).
* A new postoperative period does not begin when using [modifier 78](http://www.findacode.com/code.php?set=CPTMOD&c=78).
* Medicare allows codes with a global surgery indicator of XXX in the MPFSDB separately without [modifier 78](http://www.findacode.com/code.php?set=CPTMOD&c=78).
* Medicare allows the lower of either 100% of the fee schedule or the billed amount for codes with a global surgery indicator of 000.
*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 patients room; a minor treatment room; a recovery room; or an intensive care unit.
[Modifier 78 Fact Sheet](https://www.wpsgha.com/wps/portal/mac/site/claims/guides-and-resources/modifier-78/!ut/p/z1/tVRdb5swFP0rfeHRss2XncekWkuzsE37aAgvk8GGeArGNU6y5tfXbJP2FSBqVR5AvrrnHF-dc4E5zGCu2EHWzMpWsZ07b_L464ckiRNM0eq9nyI0T2_ugzd0taAfMbyHOcxLZbXdws1Rd1dlq6xQ9kqoeie7rYdsq2UJSlcTxkPljsmm81C9l1x0gCkOjOjavSmFqzYtl5UUBhDa8-pScrgpCAl4EQUAEVaAkLkXRXEMAh7PMIn9uGQUrkcuuiRhBPPxOdZTg_Z4NPDM0Sg-QLfBZfojAhP45UjDj_mdk_Lbw0M-d3b1Fn23MDvr17ZthIe0MF2fAHkSHPSlnsA36XVaO1-Y3QKpqhZm__eN3WRxl4YDREocf8ZhrzmzooOZjzABCKMIaNMeXFwMEH3X5aP8HT1rmFRS1R76V8tDg1rrPocTzk5lY-O8JYPevHXmH6Q4wi-qNY3buU-_o-_HRSV4OQOcxT4Ii8oHhY8xCKOQRoLMBMUzmEwqkBcqjNEvKAmH6S_a3Ql6_Lr05IX0y6nVfGZcL_9Tnl-ocziY_YnTTUODRyklyIvH4LRKdgednBbvwO11QY-fq-bXZ027-RMs8m25/dz/d5/L2dBISEvZ0FBIS9nQSEh/)
**References:**
* [WPS - Government Health Administrators](https://www.wpsgha.com/wps/portal/mac/site/home/personalized-home/!ut/p/z1/tZNLc9sgFIX_SjZeMjwkG7S0M21U12o7fcSyNh0kQKZjAUGy3fjXByVddNpKapopGwbE-e7VnHNhAXNYGH7SNe-0NfwQzrti8fVDmi5SzNDmPckQWmavb6NXbLOm8)
* [https://www.findacode.com/code.php?set=CPTMOD&c=78](https://www.findacode.com/code.php?set=CPTMOD&c=78) https://www.findacode.com/code.php?set=CPTMOD&c=78
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