Modifier 79 is used to indicate that these surgeries are unrelated to the pterygium surgery. You enter the pricing modifier directly to the right of the procedure code on the claim. In this case, it is appropriate to append modifier -59 to unbundle since it was known preoperatively that the patient needed both procedures. Insurance companies and government agencies have agreed to pay a certain fee for each covered service or procedure identified by a CPT code. For example, if a provider calls in unnecessary physician consults or procedures, he or she may be trying to pad the bill. Append modifier GA when you issue a mandatory ABN for a service as required, and the ABN is on file. Keep up with medical billing and coding trends. All Rights Reserved. The global fee for the initial surgery includes additional related surgical procedures that do not require a return to the operating room.. Outpatient physical therapy, occupational therapy, or speech language pathology, Durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS), Gender-specific services for patients who are transgender, are intersex, or have ambiguous genitalia. Examples featuring indicator 1. Contact Us for a Free, Confidential Consultation. Medisys Data Solutions Inc. All rights reserved. A patient comes for a set of 3 trigger point injections as per the plan, the physician cant bill these injections for an office visit unless the patient presents another problem. The ASST SURG (Assistant at Surgery) column provides information related to these modifiers: The ASST SURG indicator will let you know whether payment for the additional provider is permitted, not permitted, or possibly permitted if documentation supports medical necessity. To do that, you apply the individual codes and a modifier Reporting the same code for the initial procedure and the unrelated procedure may be appropriate, as this example of proper modifier 79 use shows: Suppose a patient has a right-eye cataract extraction reported using 66984 Extracapsular cataract removal with insertion of intraocular lens prosthesis (1 stage procedure), manual or mechanical technique (eg, irrigation and aspiration or phacoemulsification); without endoscopic cyclophotocoagulation.
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