Modifier 79

Modifier 79 | Unrelated Procedure During Postoperative Period

Modifier 79 describes an unrelated procedure or service by the same physician or another qualified healthcare professional during the postoperative period. It tells the payer that a procedure is unrelated to the initial surgery and should not be included in the surgical package payment for the initial procedure.

1. What is modifier 79?

Modifier 79 is a modifier that indicates that a procedure is unrelated to the initial surgery and should not be included in the surgical package payment for the initial procedure.

It is used when a patient undergoes surgery and then needs another procedure performed by the same provider, but the procedure is unrelated to the initial surgery.

Modifier 79 is appended to the procedure code for the unrelated procedure to indicate that it is not part of the surgical package payment for the initial procedure.

2. When to use modifier 79?

Modifier 79 is used when a patient undergoes surgery and then needs another procedure performed by the same provider, but the procedure is unrelated to the initial surgery.

It is appropriate to use modifier 79 when the second surgery occurs on a different body part or side of the body or when the provider links a second procedure to a different diagnosis and does not mention a complication.

Modifier 79 should not be used for repeat procedures. Instead, modifier 76 should be appended when the same provider performs the repeat procedure, and modifier 77 should be appended when a different provider performs the repeat procedure.

3. Description

The official description of modifier 79 is “Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period.”

4. Examples

Examples of procedures that require modifier 79 include a patient who has a sling operation to treat stress urinary incontinence and then returns to the operating room during the global period for the procedure due to kidney stones, which are removed by the same urologist who performed the sling operation.

The kidney stone removal is unrelated to the sling operation, so modifier 79 is appended to the procedure code for the kidney stone removal to indicate that it is not part of the surgical package payment for the initial procedure.

5. Documentation

Documentation requirements for using modifier 79 include a clear indication in the medical record that the procedure is unrelated to the initial surgery and a description of the reason for the unrelated procedure.

The documentation should also include the date of the unrelated procedure and the procedure code with modifier 79 appended.

6. Billing

To bill for a procedure with modifier 79, the procedure code for the unrelated procedure should be appended with modifier 79. The claim should also include documentation that supports modifier 79, such as a clear indication in the medical record that the procedure is unrelated to the initial surgery and a description of the reason for the unrelated procedure.

7. Common mistakes

One of the most common mistakes with modifier 79 is determining whether the procedure was unrelated to the initial surgery and its global period. Ensure that the second procedure is unrelated to the initial surgery before appending modifier 79.

Another common mistake is using modifier 79 for repeat procedures, which should be billed with modifier 76 or 77 instead. It is essential to query the provider if there is any uncertainty about whether to use modifier 79.

8. Other modifiers related to modifier 79

Other modifiers related to modifier 79 include modifier 78, used for a return to the operating room for a related procedure during the postoperative period, and modifier 58, used for a staged or related procedure during the postoperative period.

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