Modifier 78 Location Question

Hello, I'm hoping that someone can help answer a question for me.
Modifier 78 states: "Unplanned return to the Operating/Procedure Room by the same Physician or Other Qualified Health Care Professional Following Initial Procedure for a Related Procedure During the Postoperative Period".
With that being said, I work for a group of general surgeons and quite often our patients are brought back into our office and taken to our patient rooms where an incision and drainage may be performed of a hematoma or a seroma. I have been considering these as "procedure rooms" since we do procedures here at the office and I have been billing these with a -78 modifier. Now I am told that the -78 is used only if the patient is taken back to the hospital operating room.
I would appreciate clarification on this if anyone has any information that they can share.
Thank you in advance.
Michelle King CPC

Comments

  • If your patient is Medicare, that is true. However, CPT stated OR/procedure room. I do not think a treatment room is considered a procedure room- the room should be designated as such.
  • The patient must be returned to the O.R. CMS defines an OR "as a place of service specifically equipped and staffed for the sole purpose of performing procedures. The term includes a cardiac catheterization suite, a laser suite, and an endoscopy suite. It does not include a patient's room, a minor treatment room, a recovery room, or an intensive care unit (unless the patient's condition was so critical there would be insufficient time for transportation to an OR)." 

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