Wiki Modifier 79?

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dvance4210

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Just wanted to make sure I am understanding the use of this modifier correctly... patient underwent IVC Greenfield filter placement in preparation for rotator cuff surgery, but during the post-op period she became SOB/hypoxia/elvation of troponins. After cardiac cath it was determined that she needed coronary artery bypass surgery by the cardiothoracic surgeon. Definition for Modifier 79 states "unrelated procedure of service by the same physician or other qualified health care professional during the postoperative period". Am I reading into this too much?

Thanks for any clarification
 
so the patient had the rotator cuff surgery and then had the SOB, hypoxia, and elevated troponins? How long after the surgery did the patient have these symptoms? I don't bill for rotator cuff surgeries but are these normal complications of that surgery?

I wouldn't think these symptoms would be normal so the modifier 79 would be appropriate. Also, during situations like this where the surgeries don't seem to be connected at all and will be billed by two different practices we don't add any global modifiers because they are two different specialties with different diagnosis codes under different TIN.
 
Jeremy, thanks for you help...so the patient had the rotor cuff surgery as an outpatient at another hospital, developed SOB, etc., then came to our hospital where we were consulted after a heart cath was performed which showed severe single vessel disease and proceeded to do an off-pump CABG x1.

So with the 79 mod-"unrelated procedure or service by the same physician OR other qualified healthcare professional during the post-operative period" would be appropriated for the cardiothoracic surgeon to use or am I totally missing the point on the usage of modifier 79? As I was re-reading your response over again, I think your saying that 79 should be used only when it's a surgery is done within the TIN group?

Thanks for your help!

Dorinda V. CPC
 
I tried your link and it didn't work, it said the webpage was not found.

what did you decided to about the modifier on your surgery? I probably wouldn't bill it with a modifier at all. Two separate practices performing two very different surgeries on a patient should pay without an issue. It can be very difficult if not impossible to know if a patient is within the global period for a surgery that is outside of your group so the insurance company shouldn't hold up the claim for lack of modifier 78 or 79.
 
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