-
If this is your first visit, be sure to check out the FAQ & read the forum rules. To view all forums, post or create a new thread, you must be an AAPC Member. If you are a member and have already registered for member area and forum access, you can log in by clicking here. If you've forgotten your username or password use our password reminder tool. To start viewing messages, select the forum that you want to visit from the selection below..
Wiki Parathyroidectomy
- Thread starter laurijean
- Start date
ljones88
Networker
I had this exact situation before. Modifier 58 is correct. We billed with 58 and the claim was paid, after notes from 1st surgery and follow up surgery were sent it with a cover letter.
From Barbara Cobuzzi, I found asking these questions re: modifier 58 helped immensely.
Ask yourself:
1) Is the original condition is being treated?
2) Is the subsequent procedure more extensive than the first because the desired outcome was not accomplished?
3) Is something being done to “finish” what was started with the prior procedure?
4) Is a procedure being done to facilitate therapy, or is it therapy following a prior procedure?
Answering yes to any of these questions will direct you to the 58 modifier.
Modifier 79 is for an unrelated procedure during a post op period. It is used in the strictest sense for care that is entirely unrelated to the prior surgery that created the current global period. More than likely, the claim for 60502 will be sent with the same or similar diagnosis as the claim for the first surgery. Edits will stop that claim and deny it for records or deny for "inappropriate use of a modifier".
From Barbara Cobuzzi, I found asking these questions re: modifier 58 helped immensely.
Ask yourself:
1) Is the original condition is being treated?
2) Is the subsequent procedure more extensive than the first because the desired outcome was not accomplished?
3) Is something being done to “finish” what was started with the prior procedure?
4) Is a procedure being done to facilitate therapy, or is it therapy following a prior procedure?
Answering yes to any of these questions will direct you to the 58 modifier.
Modifier 79 is for an unrelated procedure during a post op period. It is used in the strictest sense for care that is entirely unrelated to the prior surgery that created the current global period. More than likely, the claim for 60502 will be sent with the same or similar diagnosis as the claim for the first surgery. Edits will stop that claim and deny it for records or deny for "inappropriate use of a modifier".
