Our surgeon performed 2 unrelated, major surgeries on the same Medicare patient on the same day. We coded the second surgery using modifier 79. Medicare reimbursed for both surgeries, but reduced our reimbursement for the second one (modifier 79) by 50%. Is this correct? I cannot find anything on the Medicare Intermediary's website which addresses a reduction in the reimbursement. It's not really a multiple procedure (modifier 51), is it?
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Wiki Modifier 79 Reimbursement Reduction?
- Thread starter gracey67
- Start date
mitchellde
True Blue
Were these performed in the same session?
mitchellde
True Blue
In this case then the 79 modifier is incorrect. The 79 is when you perform unrelated surgeries in diferent session, the patient must leave the OR and be returned then within the post operative timeframe of the 1st procedure.
If you have 2 unrelated procedures in the same session, unless a CCI edit exists for the 2 procedures, there is no need for a modifier, but the second procedure will reduce and there is nothing you can do to make it stop. The patient did not need to be reprepped and the sugeon did not have to reprep so this portion of the reimbursement is "carved out" of the second procedure.
If you have 2 unrelated procedures in the same session, unless a CCI edit exists for the 2 procedures, there is no need for a modifier, but the second procedure will reduce and there is nothing you can do to make it stop. The patient did not need to be reprepped and the sugeon did not have to reprep so this portion of the reimbursement is "carved out" of the second procedure.