Ophthalmic Coding Specialist Practice Test

Which CPT modifier represents an unplanned return to the operating room?

1. -50

2. -57

3. -78

4. -79

The correct answer is: -78

The CPT modifier that represents an unplanned return to the operating room is -78. This modifier is specifically designated for use when a patient requires a return to the operating room for a related procedure due to complications that arise from the original procedure within a specified timeframe, typically within the global surgical period. Using modifier -78 helps convey the necessity of the additional surgical procedure and clarifies to the payer that it is related to the initial surgery. It is important in coding because it affects both the billing and reporting of how many procedures were performed, ensuring that the healthcare provider is compensated accurately for their additional work and the complexity of the patient’s medical situation. In contrast, the other modifiers serve different purposes. Modifier -50 indicates bilateral procedures, modifier -57 represents a decision for surgery, and modifier -79 indicates an unrelated procedure during the postoperative period. Therefore, when coding for an unplanned return to the operating room, modifier -78 is the appropriate choice.