Wiki MODIFIER 79 OR 78?

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Rmivy

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I am billing Railroad Medicare and all of my secondary Cataract SX are denying saying denied for "modifier is inconsistent w/ procedure billed". They paid the first eye and the second is being billed within the global period so I added the 79 modifier in the first position and RT or LT eye Modifier in the secondary position. They continue to deny my claims. The rep was saying its the modifier and that all she could tell me. I resub again removing the eye modifier and kept the 79 for the global and its still denying. Can someone please guide me on this. I am at a loss right now.
 
Modifier 79 is correct for this situation and per Medicare policy that should exclude it from the previous surgery's global period. So unless there's another issue with the claim that's causing a problem, I don't know why it would be denied. If you're not getting a proper explanation from the Medicare rep, I would request they escalate the inquiry to a higher level representative, or else submit a written appeal or request for reconsideration.
 
Your post on the other thread added the info that you're billing for a facility, so I responded there as well. Global periods apply only to professional claims, so there's no need for a modifier 79 on the faciilty claim - that's likely your problem here.

Please try to avoid posting a duplicate question at the same time here on the forum.
 
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