It might be confusing when you come across unknown codes like Modifier 79. You might be wondering what it is about it or how to deal with it, right!
Here we’ll disclose everything about it in brief along with some regular queries about it.
What is Modifier 79?
Modi 79 can be defined as a procedure code that is used to indicate that the service offered to the patient is an unrelated procedure that was performed by the same physician during the postoperative period.
It is an informational modifier where no extra documentation is needed to be submitted with the claim. All one needs to submit is the supporting documents in the patient’s medical record which must showcase that the surgeries are not similar or not related to each other.
It is quite predominant that when Code 79 is used, it is the time when the global period gets normalized whereas, when the procedure is billed for the unrelated surgeries, then a new period begins as the postoperative period.
Some useful examples on when to use the Modifier 79 code.
Modifier 79 code is used in various situations, for instance,
A situation where the Modifier 79 Code is Used:
A patient has fallen and broken his ankle. An orthopaedic surgeon treats it and a few weeks later, the same patient falls and breaks her wrists.
He is treated again by the same orthopaedic surgeon who may choose to bill for the second procedure using code 79.
It might appear that the same patient and the same surgeon are involved in the operation performed, so there the code must be applied.
But, as per the HMSA policies, it clearly states that it doesn’t matter if the patient and the surgeon are the same, if the operation date is different and the type of surgery is not related to the previous one, then 79 code won’t be applicable.
Not to mention, there is no payment deduction for introducing the 79 code, so the one would be paying the full fee schedule amount.
FAQ:
Ans. The important things to keep in mind about modifier 79 are that it can only be submitted with the surgical codes.
Also, append 79 should be done to the second procedure within the global period.
Ans. The inappropriate uses of 79 Mod include
The procedure performed is related to the original surgery or staged surgery. Placed on CPT codes with XYZ, (The global concept does not apply), in the global field of the MPFSDB (Medicare Physician’s Fee Schedule Database). If related to the original procedure, it is considered part of the global period treatment.
Ans. The modifier 79 can be distinguished for an unrelated procedure and does not require that the service/procedure be performed in an operating room.
However, modifier 78 can be appended if the procedure takes place in an operating room.
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