Wiki Modifier help

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Rufus186

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Hi all,

I would appreciate any insight on how to choose the correct modifer for the following case:

Patient had arthroscopic shoulder surgery with several procedures including a bicep tenodesis (29828) due to tendinitis. During the global period the patient was carrying some boxes that were not that heavy when one started to fall when he acted abruptly to grab it with his hand causing a painful pop and later confirmed a reruptured bicep tendon. Patient presents for open repair (23430) in the global period.

Any thoughts?
Thank you in advance.
 
I would use modifier 79 on the open repair code (23430).

The reason being is because the repair is unrelated to the original surgery. The patient originally had a bicep tendonesis because of tendinitis. During the global period, the patient injured their arm and now presents with a biceps rupture (due to injury and NOT the original surgery) and needs the tendon repaired.

https://www.aapc.com/blog/24234-choose-which-to-use-modifiers-58-78-or-79/
 
Thanks all for your response.

I am starting to question if modifier 78 would pertain my case.

I took a Karen Zupko coding seminar where they went over a bit (not a lot) on modifiers 58/78/79. An example given for 78 was Pt is in global for THR, 3 weeks later slipped and fell pt brought to OR for relocation of hip due to dislocation.

Again any thoughts?


Thank you :)
 
Modifier 79. 78 would indicate it is somehow related to the orginal issue, not just the orginal body part/area.

"Modifier 79. Modifier 79 is defined by CPT as “unrelated procedure or service by the same physician during the post-operative period.” It is used in the strictest sense for care that is entirely unrelated to the prior surgery that created the current global period.

For example, a patient who is in the post-op period for arthroscopic shoulder surgery may fall and fracture their leg. Care of their leg is unrelated to the global period created by the shoulder surgery and therefore, any procedure for the leg would have a 79 modifier appended. Services that qualify for a 79 modifier may be performed anywhere."

http://www.physicianspractice.com/pearl/understanding-modifiers-58-78-79
 
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