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Modifier 78 or 79?

  1. #1
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    Default Modifier 78 or 79?
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    I have an interesting question - My Dr (Dr A) sees a pt injured on a motorcycle. Dr B performs ORIF of tibial plateau. Dr A, my guy, performs menisectomy and MCL open repair.

    Pt returns to Dr A for removal of external fixator and I&D from the ORIF. The surgeries are from 1 injury. Yet my Dr did not perform ORIF but since he saw pt already and removal is from the same injury should I bill out with 78 modifier?

    I don't want to use 79 modifier unless I'm 100% certain. Thanks as I think this one could be tricky.

  2. #2
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    Was the removal planned? What about a -58?

  3. #3
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    The original procedure was done by a different Dr which would rule-out 58. I guess my question is since it was the same accident would that rule-out the 79 modifier?


  4. #4
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    I'm assuming that Dr A and Dr B are NOT in the same practice and/or do NOT have the same tax ID. On that assumtion, if your Dr did an I&D on Dr. B's procedure, then you would bill with modifier 55 since your Dr. is assuming the "Post Operative care only". If they are under the same tax ID, then modifier 78 would be the modifier needed here. Hope this doesn't had to the confusion.
    Ray Galvez CPC

  5. #5
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    Quote Originally Posted by RGALVEZ View Post
    I'm assuming that Dr A and Dr B are NOT in the same practice and/or do NOT have the same tax ID. On that assumtion, if your Dr did an I&D on Dr. B's procedure, then you would bill with modifier 55 since your Dr. is assuming the "Post Operative care only". If they are under the same tax ID, then modifier 78 would be the modifier needed here. Hope this doesn't had to the confusion.
    What is the reimbursement % of modifier 55? I would think modifier 79 would be better since it was "unrelated" to my Dr's first surgery? This is a little confusing.

  6. #6
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    Seattle First Hill
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    Sorry, I didn't realize that the doctors were not in the same group. Personally, I would go with a -79 in this case since it is not related to the surgery that your doctor performed.

  7. #7
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    I agree with the 55 regardless of the reimbursement it is the right modifier. You are taking over the postoperative portion of a procedure performed by a different surgeon.

    Debra A. Mitchell, MSPH, CPC-H

  8. #8
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    Quote Originally Posted by mitchellde View Post
    I agree with the 55 regardless of the reimbursement it is the right modifier. You are taking over the postoperative portion of a procedure performed by a different surgeon.
    I don't code on reimbursement but I need to know since my Dr is going to want to know. It seems to me that I'm getting responses for 55 and 79. I knew this was going to be a tough one.

  9. #9
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    When your physician takes over the care of the original surgery in the global time, it should be a -55 modifier....we see many trauma cases in our practice that the original accident happened in another state and when the patient comes home they come to our practice. You have to be certain to bill the exact CPT code the original surgeon used. The 55 modifier tells the carrier that you want part of that original reimbursement.
    jdemar, CPC, CMA

  10. #10
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    Ok...Thanks. Looks like 55 is the correct way to code this procedure. I'm glad I asked because I was looking at either 78 or 79. Better safe than sorry!

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