Global Period Modifiers: How Do They Impact Reimbursement?

September 1, 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 09/01/16.


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