Modifiers 78 and 79 Procedures During the Postoperative Global Period

By Linda Tauber, CPC, CPMA, CRC, CPB | AAPC Approved Instructor

When a patient receives another procedure during a postoperative global period, the coder must determine how the new service relates to the original surgery. Modifiers 78 and 79 communicate two very different circumstances: a related return for additional treatment or a clinically unrelated procedure.

Modifiers 78 and 79 apply when a subsequent procedure or service occurs during the postoperative period of another procedure. Before assigning either modifier, verify the global-surgery indicator of the original procedure and determine whether the new service occurred within that period.

Use modifier 78 when the same provider performs a related procedure during the postoperative period and the patient requires an unplanned return to an operating or procedure room. The return may involve treatment of a complication, but CMS notes that modifier 78 is not limited exclusively to complication treatment.

• The patient is still in the global period.
• The subsequent procedure is related.
• The return is unplanned.
• The service requires an operating or procedure room.

Global-Period Effect: Modifier 78 generally does not begin a new postoperative period. The original global period continues.

Use modifier 79 when the same provider performs a procedure or service during the postoperative period that is unrelated to the original procedure. The documentation and diagnosis coding should demonstrate that the new condition and service are clinically separate from the first surgery.

• The patient is still in the global period.
• The new procedure or service is unrelated to the original procedure.

Global-Period Effect: The unrelated procedure begins a new postoperative global period of its own.

Modifier 78 describes an unplanned related return to an operating or procedure room. Modifier 58 may be appropriate when the related procedure:

• Was planned or staged.
• Was more extensive than the original procedure.
• Was performed as therapy following a diagnostic surgical procedure.

1. Confirm that the patient is still within the postoperative global period.
2. Determine whether the new procedure is related or unrelated.
3. For a related service, determine whether the return was unplanned and required a procedure room.
4. Choose modifier 78 for the related unplanned return or modifier 79 for an unrelated procedure.
5. Review modifier 58 for a planned or staged procedure and modifier 24 for an unrelated E/M service.

• Using modifier 78 for every postoperative complication without a return to a procedure room.
• Using modifier 78 for a planned or staged procedure.
• Using modifier 79 simply because a different diagnosis code appears.
• Appending modifier 79 to an unrelated E/M service instead of reviewing modifier 24.
• Failing to identify the global period of the original procedure.
• Using either modifier without documentation supporting the circumstances.

The correct choice between modifiers 78 and 79 depends on the relationship between the two procedures. Review the documentation, confirm the global period, and determine whether the new service was related, unrelated, planned, or unplanned before assigning the modifier.