Would a minor surgery room located in a physicians office qualify as an operating room for this purpose?
A. No, although physicians occasionally do outfit surgical suites in their offices. The MCPM (Chapter 12, §40.1B) details what constitutes an operating room by stating: “An OR for this purpose is defined 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, an intensive care unit…” Q. When is modifier 78 used? A. Most related care provided to a patient in a global period following surgery is not separately billable. Modifier 78 is used to inform the payer of the unique circumstances and place of service (i.e., return to OR) that justifies separate reimbursement. “Related care” is defined such that the problem or condition reported by the patient or identified by the surgeon is connected with the initial surgery. In general, the return to the OR within the postoperative per
