Modifier 78 or 79? - I have a patient who had an unrelated

wtirre

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I have a patient who had an unrelated procedure done on the opposite hand within the original surgery 90 day global period. Would I use a 79 modifier on the 2nd surgery or a 78 modifier? It isn't a complication, it is just another procedure on the opposite hand. For example, Carpal tunnel done on left wrist and 2 months later it is done on the right wrist. I used LT/RT modifier but Medicare is denying it. Please help. Thank you!
:)
 

wtirre

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Okay, so would CTS on the right and CTS on the left 2 months later be repeat procedure even though it is different area? I'm so confused so thanks for the feedback
 

jmcpolin

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I think yes because 79 is for unrelated, for example when a radiologist reads a shoulder xray on the right and then one on the left some people would rather bill 73030-26 and then 73030-26-76 instead of 73030-26-RT and 73030-26-LT. I think 79 would be like if they did a completely different procedure in a different region of the body like first procedure on neck and then second procedure on the lower back.
 

wtirre

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Thank you for the example and your feedback. I will go with the 76 modifier and see what Medicare does with that.
 

jmcpolin

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Well I just read some more info on 76 modifier and that says it has to be the same day. 58 modifer is for staged or related so I would definately go with the 58 modifier.
 

mhstrauss

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Thank you for the example and your feedback. I will go with the 76 modifier and see what Medicare does with that.
Just another opinion on this...but I'd go with modifier 79 in this situation. Yes, the same procedure code is being used, but it's not a "repeat" service, per se; it's just a coincidence that both procedures involved are on the hands. I wouldn't go with the 58 either, because it is not related to the original procedure; again, it just so happens that the same code is being used.

There was a similar question awhile back regarding knee surgery with some good input; I'll try to find the thread and post the link for you. :)
 

wtirre

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Return to OR? - replies and feedback

Wow, that is great and I really appreciate all the quick replies and feedback! I think I will go with 79 modifier after all :)
 

jmcpolin

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You are right I found an article that shared an example of cataract surgery on the left eye the right eye a few months later and they billed it with a 79 modifier, I have a hard time making sense of that in my brain lol
 

penguins11

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I agree with the 79. This was discussed in a Neurosurgical coding seminar and we were told to use 79. It is a totally different hand, so 79 would be the correct modifier.
 

jk2003

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79 is the better modifier to use... unrelated even if the same procedure is being rendered. Remember, it is a different site/location.
 
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