Modifier 79 is appended to a procedure to indicate that the same surgeon took the patient back to the operating room during the global surgical period for an unrelated problem. The second procedure must be unrelated to the original procedure. See modifier 78 for return trips to the OR that are related, and modifier 58 for return trips to the OR that were planned or staged.
The second procedure must be performed by the same surgeon during the global post op period. The reason for the surgery must be unrelated to the first surgery. A new global period starts when the physician uses this modifier.
On Feb 13, 2009, CMS issued a transmittal about this topic. It is attached as a resource. It notes that using modifier 79 bypassed carrier edits, which prevented payments during the global period. However, the OIG found that some providers were using it to bypass these edits when it was not appropriate.
Medicare's rules for billing during the global period are in the Medicare Claims Processing Manual, Publication 100-04, Chapter 12, Section 40.
If you have questions or comments about this article please contact us. Comments that provide additional related information may be added here by our Editors.
Be sure and check out this discussion with LaMont Leavitt (CEO of innoviHealth) and Christine Taxin (Adjunct professor at New York University, President of Dental Medical Billing, and Links2Success).
Some of the resources and tools they discuss will help you with your dental coding/billing and education.
Do You Have All the Right ...
The American Medical Association (AMA) recently announced the addition of two more CPT codes in relation to COVID and the Public Health Emergency (PHE). Codes 99702 and 86413 were posted to the AMA website on Tuesday, September 8, 2020 and new guidelines have been added as well.
Every healthcare office needs to know and understand the rules that apply to billing services and supplies. What lessons can we learn from the mistakes of others? What if we have made the same mistake?
Discussion between innoviHealth CEO, LaMont Leavitt and Guest speaker, Christine Taxin who is an Adjunct professor at New York University, and President of Dental Medical Billing and Links2Success about making sure you have all the right Dental resources needed to succeed in Dental Medical Billing and Coding.
The COVID-19 public health emergency (PHE) has created some possible problems when it comes to risk adjustment. Be sure your organization has implemented policies and procedures to try and overcome these new hurdles.
My colleagues and I are nerds for information on all things billable—or not billable—in the worlds of dental and medical insurance. One of the most puzzling challenges for me over the past 15 years of teaching has been to understand why we on the dental side are segregated out of ...