Author Topic: modifier to allow sep payt for same surg typ, diff day  (Read 1689 times)

jenfogle

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modifier to allow sep payt for same surg typ, diff day
« on: January 20, 2009, 01:01:47 PM »
Hi- We always know where to go when we cant find the answers anywhere else & boy have I looked for this one! 
The dr has seen a pt several times to remove lesions (approx once per 8 days). She is billing an E&M & 17000/17003 each time. The 17000/17003 will get pd on the first visit, but when the pt returns the following wk, mcr is considering the cpt's global to prev procedures... I dont think the 51, 59 or 76 mods are appropriate.  What modifier indicates same procedure/different sites/different days?

Thanks so much!
Jen


Michele

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Re: modifier to allow sep payt for same surg typ, diff day
« Reply #2 on: January 20, 2009, 05:38:10 PM »
The 79 modifier indicates an unrelated Procedure or Service by the Same Physician During the Postoperative Period.  This should work for you.

Michele
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Pay_My_Claims

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Re: modifier to allow sep payt for same surg typ, diff day
« Reply #3 on: January 20, 2009, 06:20:53 PM »
there is a difference between a global period and a post op period. A client has hip surgery and during his post op period he falls and breaks his shoulder, you then code with the 79 mod. This lets the payor know that yes he is in his post-op period (which he gets a follow visit thats included) but he had a issue unrelated to his previous issue that you are now billing for. If he has complications from his hip surgery you don't use the 79 mod. The 79 mod isn't used when related to the global period. I apologize if I am mistaken...and would like to see the data so I won't make an error.

Michele

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Re: modifier to allow sep payt for same surg typ, diff day
« Reply #4 on: January 21, 2009, 01:23:37 PM »
I was originally leaning towards the 59 but in the description in the CPT book it indicates that it is used for distinct procedures performed on the same day.  I know what you're saying on the global period vs post op but I don't see any other modifier to indicate the situation.

Also, based on the original message I was assuming they had already tried the 59, but after rereading it I'm not sure. 

This is one of those I would love to know the final answer on but it looks like the only way to find out for sure is to bill it. 

Keep us posted on how you make out.

Thanks
Michele
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Pay_My_Claims

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Re: modifier to allow sep payt for same surg typ, diff day
« Reply #5 on: January 21, 2009, 04:57:18 PM »
True, and it is the most abused modifer out there. Its used as a cure for all sometimes. If not mistaken mod 59 can be used also on separate encounters. The only reason I wouldn't use 79 because according to the coding flow chart for 79 if the pt is in a global period (back up). I would like to also know how it turns out.

Michele

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Re: modifier to allow sep payt for same surg typ, diff day
« Reply #6 on: January 22, 2009, 06:49:08 AM »
Jen,
   Keep us posted and let us know which one you ended up trying.

Michele
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jenfogle

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Re: modifier to allow sep payt for same surg typ, diff day
« Reply #7 on: January 26, 2009, 09:34:54 AM »
thank you for all of your feedback... I'm glad I am not the only one stumped here.  I will be sure to update you both on the outcome!