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Thread: Modifier 78 or 79? - I have a patient who had an unrelated

  1. #1
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    Default Modifier 78 or 79? - I have a patient who had an unrelated

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    I have a patient who had an unrelated procedure done on the opposite hand within the original surgery 90 day global period. Would I use a 79 modifier on the 2nd surgery or a 78 modifier? It isn't a complication, it is just another procedure on the opposite hand. For example, Carpal tunnel done on left wrist and 2 months later it is done on the right wrist. I used LT/RT modifier but Medicare is denying it. Please help. Thank you!

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    if you knew the surgery was going to happeen and it was planned then you would use modifier 58.
    Jenifer McPolin CPC, CPMA, RCC

  3. #3
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    What if it was not planned, but not a complication?

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    What about 76 if it was the exact same procedure
    Jenifer McPolin CPC, CPMA, RCC

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    Okay, so would CTS on the right and CTS on the left 2 months later be repeat procedure even though it is different area? I'm so confused so thanks for the feedback

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    I think yes because 79 is for unrelated, for example when a radiologist reads a shoulder xray on the right and then one on the left some people would rather bill 73030-26 and then 73030-26-76 instead of 73030-26-RT and 73030-26-LT. I think 79 would be like if they did a completely different procedure in a different region of the body like first procedure on neck and then second procedure on the lower back.
    Jenifer McPolin CPC, CPMA, RCC

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    Thank you for the example and your feedback. I will go with the 76 modifier and see what Medicare does with that.

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    Well I just read some more info on 76 modifier and that says it has to be the same day. 58 modifer is for staged or related so I would definately go with the 58 modifier.
    Jenifer McPolin CPC, CPMA, RCC

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    Quote Originally Posted by wtirre View Post
    Thank you for the example and your feedback. I will go with the 76 modifier and see what Medicare does with that.
    Just another opinion on this...but I'd go with modifier 79 in this situation. Yes, the same procedure code is being used, but it's not a "repeat" service, per se; it's just a coincidence that both procedures involved are on the hands. I wouldn't go with the 58 either, because it is not related to the original procedure; again, it just so happens that the same code is being used.

    There was a similar question awhile back regarding knee surgery with some good input; I'll try to find the thread and post the link for you.
    Meagan Strauss, CPC, CEMC
    Coding Coordinator
    The NeuroMedical Center
    Baton Rouge, LA

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    Found it It is a very thorough discussion of a similar situation; the only difference that I can see it that this one involves knees instead of hands, but same principle. Hope you find it helpful!!

    http://www.aapc.com/memberarea/forum...ad.php?t=62952
    Meagan Strauss, CPC, CEMC
    Coding Coordinator
    The NeuroMedical Center
    Baton Rouge, LA

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