Urology Coding Alert

Question: When can I bill modifier -79 with an office visit?

New York Subscriber  
Answer: Do not append modifier -79 (unrelated procedure or service by the same physician during the postoperative period) to an E/M service code. The correct modifier for an E/M service provided within the global period of surgery is modifier -24 (unrelated evaluation and management service by the same physician during a postoperative period).
     
However, there are times when you might use modifier -79 on a surgical procedure done in the office, as well as modifier -24 for the E/M service (office visit) provided during that same encounter.
 
For example, a patient comes to the office complaining of blood in the urine one month after a hydrocelectomy (55040, excision of hydrocele; unilateral), a procedure with a 90-day global period. The patients new complaint is gross hermaturia (599.89). Link diagnosis code 603.0 (encysted hydrocele) to 55040. 
 
During the visit, the urologist performs a comprehensive examination to assess the cause of the bleeding and then determines that a cystoscopy (52000) is required. Append modifiers -24 and -25 (significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to the E/M code, and modifier -79 to 52000. For example, bill 99213-24-25 and 52000-79.
     
For Medicare patients, the diagnosis for the office visit and the surgery can be the same (in this case 599.89). However, it should be different from the diagnosis for the original surgery (603.0).