“I performed a partial 1st ray amputation that included the hallux and part of the 1st metatarsal. The site did not heal, and a new infection developed at the amputation site. The result is a return to the operating room for a right trans-metatarsal amputation. For the subsequent surgery, I used Modifier 78. After all, this was an unplanned return to the operating room. I evaluated the patient post operatively and I am wondering which date should I be using for the 90-day global period?”
Since the subsequent surgery was directly related to the initial surgery, the 78 modifier was the correct modifier to append to the CPT code for the trans-metatarsal amputation, CPT code 28805. The 78 modifier is defined as the following: UNPLANNED RETURN TO THE OPERATING/PROCEDURE ROOM BY THE SAME PHYSICIAN FOLLOWING INITIAL PROCEDURE FOR A RELATED PROCEDURE DURING THE POSTOPERATIVE PERIOD. It may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). When this procedure is related to the first and requires the use of an operating or procedure room, it may be reported by adding modifier 78 to the related procedure.
Modifier –78 reimburses the surgeon approximately 80 percent of the allowed amount, depending on the payer, but it does not restart the global period. The global period continues to run from the first procedure. Therefore, the global period for the posted scenario is based upon the primary procedure that was performed, Amputation, metatarsal, with toe, single, CPT code 28810.
This is my opinion.
Michael G. Warshaw
DPM, CPC
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