Wiki modifiers 26 and 79

[johncyrose]

I have a provider who performed 33223 for z45.02 on 11/26/2019 (90-day global). The same provider performed 93458-26 for I25.10 on 01/24/2019. 93458-26 is getting denied for being included in the global surgical package. Is it appropriate for me to append modifier -79 to 93458-26? I am getting mixed information when I do an online search. I found an out-of-state payer website where it said that modifier -79 may not be used for non-surgical procedures, hence I am stumped. I appreciate input from others who may have encountered a similar situation in the past. Thanks.

 

[thomas7331]

For practical purposes of when to know if a 58, 78 or 79 modifier is applicable to a code, surgical procedures can be defined as any codes that have been assigned a global period (0, 10 or 90 days). So in your example, if you look up 93458-26 in the PFS, it does in fact have a global period of zero days assigned. So while it's true that modifier -79 should not be used for non-surgical procedures, this particular code is in fact considered a surgical procedure under the fee schedule and will hit the edits if it fall into the post-operative period of another procedure. The -79 modifier is appropriate to this code and should be used, assuming of course that the documentation supports it.

 

[johncyrose]

Thank you so much, thomas7331. That's really helpful.