The post op scope and/or debridement occur after balloon sinuplasty or traditional sinus surgery. If we are in a global period, it is related to CPT 30117 or CPT 30520. The debridement is performed to remove crusting, tissue, and clots from the turbinates. We add the 79 modifier to indicate the debridement is not related to the global period / code.
Some of the Insurance companies that we are seeing the denials with are UHC/UMR, Anthem BCBS Medicare Adv, and a few random insurance companies. Then we have some payers that pay with no problem at all. When the payer is denying for C0-4, is it appropriate to leave it to the individual payers to determine their policy? In that case we would submit a corrected claim without the 79 modifier?
Some of the Insurance companies that we are seeing the denials with are UHC/UMR, Anthem BCBS Medicare Adv, and a few random insurance companies. Then we have some payers that pay with no problem at all. When the payer is denying for C0-4, is it appropriate to leave it to the individual payers to determine their policy? In that case we would submit a corrected claim without the 79 modifier?