Have you tried billing an unrelated service during the global period and faced a denial? Well, that is probably because you are not using a modifier or appending the wrong one. We understand that billing for an unrelated service within the global period of the previous surgical services is complicated.
That is why we have decided to discuss a modifier that can help you bill your services with more clarity in the post-operative period.
Here is a complete laydown guide on modifier 79. It includes all you need to know about this surgical modifier.
Modifier 79 – Description
The American Medical Association (AMA) defines modifier 79 as an “unrelated procedure or service by the same physician during the post-operative period.”
Essentially, you will use this modifier when a provider has performed another unrelated procedure within the global period of the first procedure. The second procedure may be planned or unplanned. Meaning, when performing the first surgery, the provider may already decide to perform another unrelated surgery. Or, the second surgery may be unplanned and performed due to medical necessity, like a life-threatening injury.
To bill this modifier, you must ensure that the same physician performed both the unrelated procedures or services during the post-operative period (10 or 90 days) of the original procedure.
Furthermore, when an unrelated procedure is billed, a new global period begins for that surgery.
Modifier 79 – Usage Examples
Let’s look at a few examples of modifier 79 to better understand its appropriate use.
Arthroscopic Wrist Surgery
Consider a patient who underwent an arthroscopic knee surgery with a 90-day global period. After fifteen days, the patient fell at home and injured his left wrist. Unrelated to the prior procedure, the same orthopedic specialist assesses the damage and conducts arthroscopic wrist surgery.
Modifier 79 must be appropriately appended to the wrist surgery CPT code, as it communicates to the payer that the second procedure is distinct from the first and should not be bundled under the global surgical package.
Toe Amputation
Suppose a patient developed an infection in his right hand. An incision and drainage (I&D) procedure was performed, which has a 10-day global period.
However, during the post-operative period of this surgery, he met with an accident and completely crushed the great left toe. He was again brought to the same physician for the treatment (amputation). The surgeon can bill this new unrelated service with modifier 79, since both services are completely unrelated.
Skin Lesion
Suppose a patient developed a malignant skin lesion on his upper back, so a dermatologist performed cryosurgery to destroy the lesion, initiating a 10-day global period.
During the follow-up visit, the patient presents with another problem. He noticed another lesion on the face that has recently increased in size and is irritating. The dermatologist determines that removal is medically necessary and performs the excision.
Since the procedure was performed at a different site and was unrelated to the initial procedure, modifier 79 will be appended to the CPT code for separate payment.
Accurate Usage Guidelines for Modifier 79
The following billing guidelines for modifier 79 will help you avoid claim denials.
Ensure Correct Use of Modifier 79
You must remember that modifier 79 is only applicable to CPT codes that are used to bill surgical procedures. Furthermore, the following are the cases when you may apply this modifier.
- If the second procedure was carried out during the recovery phase (post-operative period) of an earlier procedure.
- Both procedures are performed by the same medical professional or by another licensed specialist in the same group practice.
- The second surgery must be unrelated to the first.
Note that the second surgery will start another global period and will also be reimbursed at 100% of the allowed amount.
Avoid Inaccurate Use of Modifier 79
There are some key points to remember and avoid while appending modifier 79. Remember that if the second surgical procedure was expected or was related to the first surgery, you cannot append this modifier.
Furthermore, if there are no global days for the previous surgery, and the Medicare Physician Fee Schedule (MPFS) states XXX under the ‘Global Days’ column, you cannot use this modifier. This modifier is exclusively for unrelated procedures performed within a global period.
If you do not append this modifier to your claim, the payer may not release a separate payment for the unrelated procedure, and you may be underpaid for your services.
Final Thoughts on Modifier 79
Modifier 79 explains that an unrelated surgical procedure was performed within the global days of the first surgery. It leads to 100% payment for the second, unrelated procedure.
We have covered all the necessary details regarding this modifier with the hope you will find this guide to be your go-to resource. Hopefully, you are now one step closer to filing clean claims. However, if medical coding is something that you’d rather outsource, consider opting for NeuraBill’s medical billing and coding services. Their AAPC-certified coders will ensure that your claims reflect precision and accuracy.
