Wiki Modfier 78 or 79???


Alvin, TX
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I have a patient who had a series of operations in February for treatment of an infected pseudoaneurysm of a previously placed femoral bypass. Two months after the operations the patient is back with a thigh wound infection.

The surgeon did an Incision and Debridement, Lavage and VAC placement. I used CPT codes 11045, 11042 and 97605. I put modifier 78 on all of these codes and the only thing the insurance is paying for is the 97605. Should 11045 and 11042 have had a different modifer like 79?

Obviously the patient developed a fever and the infection on a previously operated wound so it was unplanned return to the OR but..... could it possibly be 79? Unrelated procedure? Extremely confused about the modifiers. And I guess I was thinking when a complication arose, we could code for that or is a wound infection not complication enough?
Did they give a reason for not paying 11045/11042? Is it LCD related? I don't think 79 would make a difference but you could try it; it seems 78 was the appropriate modifier.

I would use 79 if, for instance, the patient has a CABG was released after a few days then suffers a open broken leg (bone through skin) which requries immediate surgery but in no way related to the CABG. In your case the patient has infection after the bypass. IMO that is related.

There must be a reason they denied the 11045/11042 and it's not NCCI.
The reason for denial....PI 96 "non-covered charge(s)."
Really, I am not sure what that is suppose to mean.