Wiki modifer 78 and 79

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carriep9829

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Hi! I am the coder/biller at a NY ambulatory surgery center. I've have been having trouble with one of our Medicare Claims. There was a patient that came into our ASC for excision of hypertrophic bone of the first metatarsal/metatarsocuneiform joint 28122, debridement/preparation of wound bed of foot 15004 and application of graftjacket 15335. This surgery was completed. The patient was in the recovery room and the Dr. found that he had developed a hematoma in the foot. The Dr. decided to bring him back into the OR for evacuation of the hematoma. I had coded this 2nd surgery as 10140-78-RT b/c it was a complication of the initial surgery. Medicare has denied this as invalid or missing modifier. When I spoke to a Medicare rep she said to try it with the 79 modifier. I tried researching the 79 modifier, but I'm not sure if it is correct in this situation? Since the global period is 24 hours for ASC, I'm not sure anymore if the 78 or 79 modifiers will still apply? (I think I've been thinking way to long on this one).

Would anyone have any suggestions? Thanks in advance for your help!
 
You need to drop the RT modifier this code is not considered a unilateral type of code, it is performed at different sites but not RT or LT. That is your invalid modifier.
 
according to ASCEXPERT, the only modifiers that would go with that code @ an ASC are 73 and 74. The surgeon would use that modifer, but I don't believe you need to use one at all.
 
73 and 74 are if the procedure were discontinued. I am sure you can use the 78 and you would need it on the same day if the 10140 is bundled into either of the other codes. You should check that for starters.
 
ok thanks. I'll try resubmitting the claim without the RT modifier. If it still comes back as invalid I'll take off the 78 modifier too. Thanks for help!!!!!
 
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