Modifier 79

Unrelated procedure or service by the same physician during the postoperative period.

Instructions

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.

Correct Use

  • 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

Incorrect Use

  • If Medicare Physician Fee Schedule (MPFS) indicator list marked with "XXX," no modifier is needed as there are no global dates

Claim Coding Example

  • Provider performs right toe amputation on May 24, 2015.
  • On June 25, 2015, a left foot amputation surgery was medically necessary within this 90 day global period
Date Treatment Description CPT/Modifier
5/24/15 Amputation big toe, RT 28820 TA
6/25/15 Amputation foot, LT 28800 79

 

Resource

 

Last Updated Tue, 25 Oct 2022 15:15:54 +0000