Reimbursement Effect of Modifier 79?

Reimbursement Effect of Modifier 79?

May 17, 2018

If I do a lesion excision with intermediate repair and the patient returns one week later for another lesion excision with repair, my staff tells me I need modifier 79 on the codes to get paid?  Is this true, and will it affect my payment?

You do need to append modifier 79 to the new procedure(s).  Modifier 79 indicates that an unrelated service or procedure is performed by the same physician during the post-operative period.  If the original excision and repair that you performed carries a 10-day global period, then all claims submitted for that 10-day period will be denied as bundled into the original procedure unless the proper modifier is appended to the new procedure code(s).  In your case, a separate, unrelated lesion excision was performed during the global period of the first procedure, so you need to append modifier 79 to the new service(s) performed in order to be reimbursed.  There is no payment reduction for modifier 79 usage, so you should be paid at the full fee schedule amount.

*This response is based on the best information available as of 05/17/18.


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