September 29, 2016
What reimbursement should we expect when using the global period modifiers 58, 79 and 78?
Global period modifiers are used to indicate that a subsequent procedure was performed during the global period of a prior procedure. Modifiers alert the payer of your rationale for allowing payment for the subsequent procedure. The modifiers and reimbursement impact of each is shown below:
Modifier 58: Indicates that a subsequent procedure was performed as a (1) planned or anticipated (staged); (2) more extensive than the original procedure; or (3) for therapy following a surgical procedure. Reimbursement should be 100% of the allowable and the global period is extended to that of the subsequent procedure.
Modifier 79: Is appended to CPT code to show that an unrelated procedure was performed during the global period of a prior procedure. Again, reimbursement should be at 100% of the allowable and you’re now in a separate global period that is related to the subsequent procedure.
Modifiers 78: Indicates that an unplanned, related procedure was performed in the operating room, catheterization or endoscopy suite. Typically this is treatment of a complication such as wound dehiscence, infection, etc. Reimbursement is typically at 70-80% of the allowable. Why? The reduction accounts for overlapping pre- and post-op care which was paid under the original procedure. Therefore, the payment for modifier 78 is for only the intra- operative portion of the unplanned, related procedure.
*This response is based on the best information available as of 09/29/16.