Second surgery denied even with mod 79

goldark1

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HI. I received a issue from a fellow coworker. She has a patient who had a foot amputation done which has a 90 day global period. Paitent had a sig flex done during the global period. That claim was denied by Medicare Part B as part of the global period. A mod 79 was attached. When she call Medicare to state the mod should be valid, they said it is not and we should be billing with another modifier.

Has anyone else seen this? The sig was not part of staged procedure. Any advise or help?

Thank you!
 

SharonCollachi

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I'm stumped. This is definitely unrelated, and I'm confused as to why 79 is being denied. I would appeal it with a copy of the definition of 79.

And I would be tempted to say "the foot is not now, and was not before it was amputated, ever connected to the rectum."
 

csperoni

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I too am befuddled by this. I'm even surprised it required a modifier at all since (at least around here), it would be highly unlikely that the same physician/group would be performing an amputation and a sig flex.
 

thomas7331

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It sounds to me as though this is either a mistake on Medicare's part, or else perhaps she has misunderstood the denial and there is another issue with the claim beside the global period that has caused them to deny it.
 
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