Wiki Modifier 79

[dsmith03@hotmail.com]

Looking for information in writing about modifier 79. My doctor has scheduled a patient for another procedure while they are still in a global. He seems to think that as long as we put a modifier 79 on it, he will get fully reimbursed. We have tried numerous times to tell him that he will only get reimbursed 50% if he does another procedure while the patient is in a global. Please advise.

 

[ross_lani@msn.com]

I believe he is correct. As long as you have a different diagnosis and it is not to treat a complication, then you should use the -79 modifier and he should be reimbursed at 100% of the allowable.

 

[dsmith03@hotmail.com]

Do you know where that is documented? My coworker won't believe it isn't true if I can't show it to her.

 

[RFoster1]

79

http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/clm104c12.pdf

pg 104

 

[OCD_coder]

Source: http://news.aapc.com/index.php/2012/09/choose-which-to-use-modifiers-58-78-or-79/

Modifier 78 - pay reduced to 50% reimbursement and the global period does not restart

Modifier 79 - pay is NOT reduced and reimburses at 100% and the global period restarts