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Thread: Modifiers 78, 79 or what?

  1. #1
    Join Date
    Apr 2007
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    Lafayette Louisana
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    Smile Modifiers 78, 79 or what?

    I work in an Ambulatory Surgery Center; we had a patient who came in for cataract removal 66984 on 10/25/11 and he had to come back on 10/26/11 to reposition the lens 66825. He went to the OR on both days. I billed Medicare with the 78 modifier first and they didn't like that, then I billed with the 79 modifier and they didn't like that either. Please any other suggestions. Do I need to use both or something else?

  2. #2
    Join Date
    Apr 2007
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    Lubbock, TX
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    Default

    Quote Originally Posted by grnis7 View Post
    I work in an Ambulatory Surgery Center; we had a patient who came in for cataract removal 66984 on 10/25/11 and he had to come back on 10/26/11 to reposition the lens 66825. He went to the OR on both days. I billed Medicare with the 78 modifier first and they didn't like that, then I billed with the 79 modifier and they didn't like that either. Please any other suggestions. Do I need to use both or something else?

    Technically, if it was unplanned, the correct modifier is 78 - you may have to appeal with records if that's the case. But, if there was a possibility that the lens would need to be adjusted from the beginning (I'm not sure if that's a common thing or not - sorry) - then you might need to use modifier 58 - see the definition in appendix A for more info. 79 is definitely incorrect, so don't use that.

  3. #3
    Join Date
    Apr 2007
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    phoenix
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    Default

    It would be 78 - it is never planned to have to reposition the lens. What diagnosis are you using?

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