Wiki 79 modifier

[sagiomavritis]

Hello,

I need some clarification on modifier 79. Scenario: Patient is in post-op period for their left knee. They come in the office to see the same provider for right hip pain. A full HPI, ROS, and PE are done for this new problem and the provider gives the patient a cortisone injection in the right hip. The E/M visit would have a 24 modifier on it to signify the non-global related service. Would a 79 modifier be correct to have on the injection procedure? Any insight would be greatly appreciated as there is a great deal of confusion if 79 modifier is for procedures in the OR only.

 

[Chelle-Lynn]

The 79 modifier, similar to the 78 modifier, does relate to services performed in OP Room.

[h=3]Examples of When NOT to Use Modifier 79::[/h]

• When the two surgeries are related.
• When a different physician performs the operation.
• When the operation happens outside the post-op period.
• When the procedure is performed somewhere other than the operating room.

 

[sagiomavritis]

The 79 modifier, similar to the 78 modifier, does relate to services performed in OP Room.

[h=3]Examples of When NOT to Use Modifier 79::[/h]

• When the two surgeries are related.
• When a different physician performs the operation.
• When the operation happens outside the post-op period.
• When the procedure is performed somewhere other than the operating room.

Thank you for clarifying, do you have any suggestion as to what modifier should be used on the 20610? Many of our payers will deny for global despite the diagnosis code being different from the global diagnosis.

 

[Chelle-Lynn]

There is a not an appropriate modifier for this scenario. In the cases where the carrier denies the claim for global, it becomes an appeal issue with medical necessity and confirmation through the medical records of the separation of services.