MODIFIER 79: Unrelated Procedure
The same doctor may perform an unrelated procedure during the postoperative period or provide customer support. Submit this modifier when the same surgeon performs a subsequent unrelated surgery within the global period of a minor or major surgery, irrespective of whether the next surgery necessitated a return to the surgery room. If a less invasive process fails and more painful surgery is needed, the process is billable separately if CPT modifier 79 is used.
Appropriate use
- Modifier 79 is added to a procedure code to imply that the service was unrelated and conducted by the same doctor during the postoperative period.
- This modifier can only be used in conjunction with surgery codes.
- The claim does not require any additional paperwork. Documentation supporting the patient’s claim must be kept in the patient’s medical record. The documentation must prove that the treatments are unrelated.
- If the successive surgery is connected to the initial surgery and needs a return to the operating room, and the same surgeon conducts both refer to CPT modifier 78.
- Suppose the successive surgery is connected to the initial surgery but does not necessitate a return to the operating room, and the same physician conducts both. In that case, the subsequent surgery cannot be forwarded individually. The total fee for the initial surgery includes any additional linked surgical procedures that do not necessitate a return to the operating room.
- E/M services performed the same day as a procedure with 0 or 10 global days are usually not billed separately from the process. Please see CPT modifier 25 for more information.
- E/M services are generally not reimbursable on the day of the process and during the 10-day postoperative period. Please see CPT modifier 57 for more information.
Inappropriate use
- The process executed is considered the basic procedure or a staged procedure.
- If the services conducted are related to the original procedure, they are included in the global period.
Example of modifiers 79
Example no. 1
On April 25, 2009, a proper cataract extraction (CPT code 66984, 90 global days) was conducted. On June 25, 2009, a left cataract extraction (CPT code 66984, unrelated to the second surgery) was performed (within the global period of the previous surgery). Because the second operation was to diagnose a different eye, use CPT code 66984 with CPT modifier 79.
Example no. 2
A correct inguinal hernia repair on March 24, 2019 (CPT code 49505, 90 global days) was conducted. A right femoral hernia repair (CPT code 49550) was performed on April 24, 2019 (within the global period of the previous surgery).
Summary
The 79 modifier has some ambiguities, but a little explanation can go huge. Here are some important details to remember about modifier 79:
- It can only be required to submit if surgical codes are included.
- Add 79 to the second process completed during the global period.
- It only pertains if the same physician performs the double procedure within the same time frame as the first.
Proper documents should be kept in the specified format as with all modifiers. The documentation must demonstrate that the surgeries are unrelated to avoid any questions from the payer.
Unfortunately, even if your code is under CPT rules, not all insurance companies will pay you for the completely separate E/M service. Make sure that your employees appeal to any rejected or bundled claims. The insurer’s evaluation of your paperwork may payout for your work. Are you still perplexed after reading the instances for modifier 79? Billing executive Medical Billing Services has a skilled coding group that employs precise modifiers to prevent denials. To learn more about our medical billing services, please contact us at rcmexpertz@gmail.com
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