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Modifier 79-Encoder pro says

  1. #1
    Default Modifier 79-Encoder pro says
    Medical Coding Books
    Do you need a modifier 79 for the following

    31500
    36556
    36620

    Encoder pro says no but what do you think

  2. Default Mod 79
    Are you in a global period? Mod 79 is unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period.

    If you are asking about mod 59 (Distinct procedural services) - according AAPC Coder, there are no bundling issues.
    Monika A. Liddle, CPC, CGSC
    2016 Member Development Officer, Sailfish Chapter of the Treasure Coast
    Past Treasurer, Sailfish Chapter of the Treasure Coast
    Past Member Development Officer, Sailfish Chapter of the Treasure Coast

    Franciscan Medical Group
    Coder II
    Port St. Lucie, FL


    No act of kindness, no matter how small, is ever wasted.
    ― Aesop

  3. #3
    Default
    if they're all completely unrelated from each other it doesn't hurt to use modifier 59 to be on the safe side. I dont know about these codes in particular but every payer is different.

  4. #4
    Location
    Columbus, Ohio
    Posts
    77
    Post
    There are no CCI conflicts so -59 modifier is not necessary. Just make sure you have your codes linked to the appropriate diagnosis codes.

  5. #5
    Default Modifier 79
    Thanks for your help. Let me clarify somethings. I work for critical care docs so none of these codes are in global period. Our "main" coder insists that there needs to be a mod 79 on a few codes. EX:

    99291 - 25
    31500 -79
    36556 - 59
    36620 - 59

    Can anyone confirm this is correct?

    I think it should be
    99291-25
    31500
    36556-59
    36620-59
    Thanks for any help.

  6. #6
    Location
    Columbia, MO
    Posts
    12,913
    Default
    Quote Originally Posted by krisw7067 View Post
    Thanks for your help. Let me clarify somethings. I work for critical care docs so none of these codes are in global period. Our "main" coder insists that there needs to be a mod 79 on a few codes. EX:

    99291 - 25
    31500 -79
    36556 - 59
    36620 - 59

    Can anyone confirm this is correct?

    I think it should be
    99291-25
    31500
    36556-59
    36620-59
    Thanks for any help.
    I would have your coder provide an explanation. She may just be confused or she may be completely incorrect. If there is no global and this is not within the global and the procedure note supports the codes you have chosen, and there are no bundling issues the the only modifier you need is the 25.
    59 helps unbundle CCI parings if supported by documentation , and 79 is for unrelated procedure in a global. So if neither of these conditions exist then no modifier is needed.

    Debra A. Mitchell, MSPH, CPC-H

  7. #7
    Default Modifier 79
    Thanks Debra

    I am the coder. Our practice manager is telling us to use the modifier 79 and I totally disagree.

    We work with all critical care docs and the 31500, 36556, 36620, etc. have "0" global days to them. I do know that the CVC and Artline need 59 to them per Encoder Pro.

    So you would NOT ever use modifier 79 unless it has a global period correct???

    Thanks

  8. #8
    Default
    That is correct. Modifier -79 would not be acceptable in this circumstance. I think that your office manager may be confused as to using the -59 modifier to distinguish the services performed.
    Amy Pritchett,
    BSHA, CPC, CPMA, CPC-I, CDEO, CANPC, CEDC, CASCC, CRC, CMDP, CMPM, CCS, CMRS, C-AHI, ICDCT-CM, ICDCT-PCS
    2017-2018 Secretary of Local Mobile AAPC Chapter
    2015-2016 President of Local Mobile AAPC Chapter

  9. #9
    Default Modifier 79
    Amy

    Thanks, would you use a modifier 59 on 36556 and 36620. EX:
    99291-25
    36556
    36620-59

    ???

    Kris

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