Wiki Surgeries in a Global


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The practice I work for is having trouble with the 79/76 and 79/59 modifier combos. Pt comes in has surgery, comes back during the global and has more surgery on multiple sites. Because they are still in a global from the first surgery I add the 79, Because it is the same procedure on the same day I add the 76. The insurance company states this is not a legal combination. All surgeries are on separate sites and clearly noted. Any help on this would be greatly appreciated.

17311 79
17312 79
17311 79 76 This line items always gets denied even if I use the 79/59 combo..
13152 79
This looks correct to me, though I would use the 59 or XS instead of 76 in this situation since it's a separate site, not a repeat procedure. Some payers may not want the 79 on the 17312 since it's an add-on code. I would push back with the payer on this - they will probably say their usual 'we can't tell you how to code', which is true, but if they're denying your claims, they should be able to refer you to some kind of payment policy in writing. If you can't get a straight answer, ask to speak to a supervisor or contact your network representative.
This looked right to me, too, so I checked in on DermCoder. According to DermCoder, you coded it correctly.

However, DermCoder is probably "assuming" that this is a repeat of the 17311, not a second site. I therefore agree with thomas7331 that you probably should use 59,79 rather than 76,79 on the second 17311.