Modifier 78 vs Modifier 79: Complete Guide for Accurate Medical Billing

Understanding the difference between Modifier 78 and Modifier 79 is essential for accurate medical billing and avoiding claim denials. Modifier 78 is used for an unplanned return to the operating room during the global period due to complications from the initial surgery. Modifier 79 applies when the same physician performs an unrelated procedure during the global period, starting a new global surgical package. Correct usage ensures proper reimbursement—Modifier 78 usually covers only the intra-operative portion, while Modifier 79 allows full payment for the new procedure. This guide explains their definitions, key differences, correct scenarios for usage, and real-world examples to help coders, billers, and providers stay compliant. We also cover common mistakes, best practices, and payer-specific considerations to improve revenue cycle management. Mastering these modifiers is crucial for accurate claims, timely payments, and maintaining compliance in healthcare billing.