Wiki MED pt had other foot done and not paying

[megantun13]

I have a medicare patient who had left bunion done in September then her right in November and medicare is denying her right foot saying it was done in post-op period. I used the rt/lt modifiers on each surgery respectively, of course, so what else can I do to get this paid?? Any ideas?

Megan

 

[mhstrauss]

I have a medicare patient who had left bunion done in September then her right in November and medicare is denying her right foot saying it was done in post-op period. I used the rt/lt modifiers on each surgery respectively, of course, so what else can I do to get this paid?? Any ideas?

Megan

LT/RT modifiers are not sufficient for a surgery that was performed during the global period of another. You also need modifier 79 on the second surgery.

 

[OCD_coder]

The modifier that best describes the scenario you present would be modifier i 79, not necissarily a laterality modifier. You have to turn off the global effect to get reimbursed for the 2nd procedure when performed during an active global period.

Definition:
"Unrelated Procedure or Service by the Same Physician or Other Qualified Health Care Professional During the Postoperative Period"