# Modifier 78 or 79? - I have a patient who had an unrelated



## wtirre (Jan 23, 2012)

I have a patient who had an unrelated procedure done on the opposite hand within the original surgery 90 day global period.  Would I use a 79 modifier on the 2nd surgery or a 78 modifier?  It isn't a complication, it is just another procedure on the opposite hand.  For example, Carpal tunnel done on left wrist and 2 months later it is done on the right wrist.  I used LT/RT modifier but Medicare is denying it.  Please help.  Thank you!


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## jmcpolin (Jan 23, 2012)

if you knew the surgery was going to happeen and it was planned then you would use modifier 58.


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## wtirre (Jan 23, 2012)

What if it was not planned, but not a complication?


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## jmcpolin (Jan 23, 2012)

What about 76 if it was the exact same procedure


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## wtirre (Jan 23, 2012)

Okay, so would CTS on the right and CTS on the left 2 months later be repeat procedure even though it is different area?  I'm so confused so thanks for the feedback


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## jmcpolin (Jan 23, 2012)

I think yes because 79 is for unrelated, for example when a radiologist reads a shoulder xray on the right and then one on the left some people would rather bill 73030-26 and then 73030-26-76 instead of 73030-26-RT and 73030-26-LT.  I think 79 would be like if they did a completely different procedure in a different region of the body like first procedure on neck and then second procedure on the lower back.


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## wtirre (Jan 23, 2012)

Thank you for the example and your feedback.  I will go with the 76 modifier and see what Medicare does with that.


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## jmcpolin (Jan 23, 2012)

Well I just read some more info on 76 modifier and that says it has to be the same day.  58 modifer is for staged or related so I would definately go with the 58 modifier.


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## mhstrauss (Jan 23, 2012)

wtirre said:


> Thank you for the example and your feedback.  I will go with the 76 modifier and see what Medicare does with that.



Just another opinion on this...but I'd go with modifier 79 in this situation.  Yes, the same procedure code is being used, but it's not a "repeat" service, per se; it's just a coincidence that both procedures involved are on the hands.  I wouldn't go with the 58 either, because it is not related to the original procedure; again, it just so happens that the same code is being used.

There was a similar question awhile back regarding knee surgery with some good input; I'll try to find the thread and post the link for you.


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## mhstrauss (Jan 23, 2012)

Found it    It is a very thorough discussion of a similar situation; the only difference that I can see it that this one involves knees instead of hands, but same principle. Hope you find it helpful!!

https://www.aapc.com/memberarea/forums/showthread.php?t=62952


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## wtirre (Jan 23, 2012)

*Return to OR? - replies and feedback*

Wow, that is great and I really appreciate all the quick replies and feedback!  I think I will go with 79 modifier after all


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## jmcpolin (Jan 23, 2012)

You are right I found an article that shared an example of cataract surgery on the left eye the right eye a few months later and they billed it with a 79 modifier, I have a hard time making sense of that in my brain lol


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## penguins11 (Jan 24, 2012)

I agree with the 79.  This was discussed in a Neurosurgical coding seminar and we were told to use 79.  It is a totally different hand, so 79 would be the correct modifier.


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## jk2003 (Jan 24, 2012)

79 is the better modifier to use... unrelated even if the same procedure is being rendered.  Remember, it is a different site/location.


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