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We are billing cpt 31231 & 31237 with mod 79 and BCBS is denying them , stating CMS and AMA rules? Is anyone else having this problem? And they are recouping for the ones that the have paid in the past.
I know that some payers have started looking at the codes for possible abuse of the modifier 79. Endoscopic exams and debridement during the global period are a normal and routine part of the post-operative care for some sinus surgeries so should be included in the global package, but I know that many practices go ahead and bill these with the modifier 79 anyway. Is your modifier supported by documentation and/or a different diagnosis than that for which the surgery is performed? If so, you may be able to appeal with records and get the denials overturned.