Wiki Post op modifier

[Terrym68]

Can someone tell me if a patient comes in for a B12 shot during a post op period what modifier I should use to get the shot paid?

 

[CodingKing]

http://www.physicianspractice.com/pearl/understanding-modifiers-58-78-79

Modifier 79 is defined by CPT as “unrelated procedure or service by the same physician during the post-operative period.” It is used in the strictest sense for care that is entirely unrelated to the prior surgery that created the current global period.

 

[Terrym68]

The 79 modifier I used was denied by Medicare. They said that is to be used only for surgical procedures. I just spoke with Medicare again and they insist this is the wrong modifier.

 

[thomas7331]

Not sure who your Medicare contractor is, but the contractor in the area where I work does not accept the post-operative period modifiers on the procedure codes in the 90000-99199 range, which would include procedures such as injections and debridements. We found that removing the modifier worked to get the claim to pay correctly.

 

[debgispert]

79 Modifier

The 79 modifier I used was denied by Medicare. They said that is to be used only for surgical procedures. I just spoke with Medicare again and they insist this is the wrong modifier.

Modifier 79 is defined as: Unrelated procedure or Service by the same physician or other qualified health care professional during the postoperative period.

I've used it in situation where a person has a surgical procedure (say a cholecystectomy) and within the 90 day global has a second procedure (like an appendectomy).

The 24 modifier goes on evaluation and management codes.

What procedure was done to put the patient in the global?

 

[Terrym68]

patient had an I&D cpt code 10060. He then came in the next week for an injection of b12 and they are denying the 96372 even with 79 modifier.