What requirement must be met to use modifier 78?

Modifier 78 is specifically used to indicate that a procedure was performed during the postoperative period for a related and unplanned complication or issue that arises. This helps inform payers that this subsequent procedure was necessary due to circumstances tied to the initial surgery, rather than being a routine follow-up or a planned intervention.

The requirement for the procedure to be unplanned is essential because modifier 78 is designed to capture unexpected events during the recovery from a primary surgical procedure. By employing this modifier, the healthcare provider can signal that the new procedure was necessary but not part of the original plan, thereby clarifying coverage and payment details with insurance providers.

In contrast, other options do not accurately capture the specific criteria for using modifier 78. For instance, a staged procedure would not be unplanned and could require a different modifier; unrelated procedures would also not meet the criteria since the complications would still be considered part of the original surgery; and while modifier 78 can apply to minor procedures, it is not a defining requirement for its use. Therefore, the key takeaway is that the event must indeed be unplanned to apply this modifier correctly.