Wiki Modifier 79-Encoder pro says

[krisw7067]

Do you need a modifier 79 for the following

31500
36556
36620

Encoder pro says no but what do you think

 

[Monika Liddle]

Mod 79

Are you in a global period? Mod 79 is unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period.

If you are asking about mod 59 (Distinct procedural services) - according AAPC Coder, there are no bundling issues.

 

[JesseL]

if they're all completely unrelated from each other it doesn't hurt to use modifier 59 to be on the safe side. I dont know about these codes in particular but every payer is different.

 

[stephanie7480]

There are no CCI conflicts so -59 modifier is not necessary. Just make sure you have your codes linked to the appropriate diagnosis codes.

 

[krisw7067]

Modifier 79

Thanks for your help. Let me clarify somethings. I work for critical care docs so none of these codes are in global period. Our "main" coder insists that there needs to be a mod 79 on a few codes. EX:

99291 - 25
31500 -79
36556 - 59
36620 - 59

Can anyone confirm this is correct?

I think it should be
99291-25
31500
36556-59
36620-59
Thanks for any help.

 

[mitchellde]

Thanks for your help. Let me clarify somethings. I work for critical care docs so none of these codes are in global period. Our "main" coder insists that there needs to be a mod 79 on a few codes. EX:

99291 - 25
31500 -79
36556 - 59
36620 - 59

Can anyone confirm this is correct?

I think it should be
99291-25
31500
36556-59
36620-59
Thanks for any help.

I would have your coder provide an explanation. She may just be confused or she may be completely incorrect. If there is no global and this is not within the global and the procedure note supports the codes you have chosen, and there are no bundling issues the the only modifier you need is the 25.
59 helps unbundle CCI parings if supported by documentation , and 79 is for unrelated procedure in a global. So if neither of these conditions exist then no modifier is needed.

 

[krisw7067]

Modifier 79

Thanks Debra

I am the coder. Our practice manager is telling us to use the modifier 79 and I totally disagree.

We work with all critical care docs and the 31500, 36556, 36620, etc. have "0" global days to them. I do know that the CVC and Artline need 59 to them per Encoder Pro.

So you would NOT ever use modifier 79 unless it has a global period correct???

Thanks

 

[Amy Pritchett]

That is correct. Modifier -79 would not be acceptable in this circumstance. I think that your office manager may be confused as to using the -59 modifier to distinguish the services performed.

 

[krisw7067]

Modifier 79

Amy

Thanks, would you use a modifier 59 on 36556 and 36620. EX:
99291-25
36556
36620-59

???

Kris