79 - JE Part A
Unrelated procedure or service by the same physician during the postoperative period
This modifier is used when an unrelated procedure or service, by the same physician, is performed during the postoperative period (10 or 90 day global) of the original procedure.
A new post-operative period begins when the unrelated procedure is billed.
- Only on surgical codes
- Append modifier 79 in first position as pricing modifier
- Not necessarily needing return to operating room
- Failure to append could result in noncoverage
- For repeat procedures on same day, append modifier 76
- If Medicare Physician Fee Schedule (MPFS) indicator list marked with "XXX," no modifier is needed as there are no global days
Claim Coding Example
- Provider performs right toe amputation on May 24, 2015, and on June 25, 2015, a medically necessary left foot amputation surgery was performed within this 90 day global
|05/24/15||Amputation big toe, RT||28820 TA|
|06/25/15||Amputation foot, LT||28800 79|
- CMS Internet Only Manual (IOM), Publication 100-04, Medicare Claims Processing Manual, Chapter 12, Sections 30 and 40.2
Last Updated Mon, 12 Dec 2022 18:32:13 +0000