Medical Auditing Practice Exam

What statement is TRUE regarding the appending of modifier 78?

1. It resets the global period

2. It only pays the intraoperative percentage and does not start a new global period

3. It automatically results in maximum payment

4. It applies only to outpatient services

The correct answer is: It only pays the intraoperative percentage and does not start a new global period

The statement that it only pays the intraoperative percentage and does not start a new global period accurately reflects the function of modifier 78 in medical billing and coding. Modifier 78 is used to indicate that a surgical procedure was performed within the global period of a previous surgery due to a complication that requires a return to the operating room. By applying this modifier, the healthcare provider communicates that they are billing for a procedure related to the initial surgery, and thus, the global surgical package from the first surgery remains in effect. This means the new surgery does not reset the global period but instead qualifies for only a portion of reimbursement, specifically the intraoperative percentage, because the care involved is considered a continuation of the original surgical care. Choosing this modifier effectively ensures that claims are handled properly under the rules of the global surgical period while avoiding unnecessary payments that would come from a new global surgical package.