Modifier 79

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Mount Washington, KY
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Hello All,
My inquiry pertains to modifier 79. In this instance the physician saw the patient in the hospital and did fracture care to the clavicle. A few weeks later he sees the patient again in his office. Only this time he does a cast to the right wrist. Modifier 79 was appended to the code for the casting of the wrist. My guess is this is due to being part of the global period. I just want to make sure this is a correct way to use this modifier. Thanks
 

Kris Cuddy

Guru
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Harrison, MI
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Hi Jessica, I know this is a late response, but hopefully it's still of some use. Your scenario is actually inappropriate use of modifier -79. I think what you may be looking for is modifier -58 which is for staged or related procedures. Here's a great quickie of modifier -79 from my MAC, WPS GHA:
Modifier 79 Fact Sheet


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Information about modifier 79.

Definition: Unrelated procedure by the same physician during the post-operative period.
Appropriate Usage

  • To describe an unrelated procedure performed during the post-operative period of the original procedure.
  • The two procedures are performed by the same physician
  • All procedure codes except those with XXX in the GLOB (global) field of the MPFSDB.
  • Used on services during the post-operative period starting the day after the procedure
Inappropriate Usage

  • The procedure performed is related to the original procedure or a staged procedure.
  • If the services performed are related to the original procedure, it is considered part of the global period.
Also, here's a great article on modifiers -58, -78, and -79, I think you'll find very useful: http://www.physicianspractice.com/pearl/understanding-modifiers-58-78-79.






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