Modifier 78, unplanned return to the operating room

Per the American Medical Association, modifier 78 is used when an unplanned return to the operating room occurs during the post-operative period of the initial or related procedure performed by the same physician or other qualified health care professional. A new global period does not begin for services reported with modifier 78.

Appropriate uses of modifier 78

Use for complications of the original service that require a return to the operating or procedure room.

Append to services with global surgery indicators of 000, 010, 090, YYY, or ZZZ if the service occurs on the same date of service or within the postoperative period of the initial or related service.

Inappropriate uses of modifier 78

  • Repeated or unrelated services
  • Staged or related procedure requiring a return to operating room
  • Different rendering provider
  • Service falls outside of the global period of the original or initial service
  • Services without global period (indicators other than 000, 010, 090, YYY, or ZZZ)


Reimbursement is based on an intraoperative percentage using the CMS National Physician Fee Schedule Relative Value File for date of service rendered. Payment reduction for intraoperative percentage applies to codes with global days only (010 or 090).