Modifier 79 is appended to a CPT code for unrelated surgery by the same urologist during the postoperative period of a procedure that he initially did a few days ago. Remember, that a separate diagnosis is necessary and the 79 modifier is appended only to the second surgical code. When using modifier 79, you will get full reimbursement for the two procedures including the second unrelated surgery. Read this expert healthcare coding article for more.
Let us assume that we have a patient who underwent a hydrocelectomy after a radical retropubic prostatectomy. On day one, he had a radical prostatectomy with nodes 55845 with the diagnosis of cancer of the prostate 185.
And then, 63 days later, within the global because his hydrocele that he had before seem to now increasing during the postoperative period. During that period, he underwent a hydrocelectomy, 55040. This surgery definitely is within the global of the prostatectomy but it's unrelated consequently, the use of modifier 79 and the new diagnosis 603.9 hydrocele.
Let's look at another example that throws more light on the apt and correct use of modifiers. Here, we have a patient who had a stent insertion for ureteral calculus after a TURP. On day one, he had his TURP 52601 and on the day 63, he had renal colic and required the stent placement. This surgery done within the global of the TURP 90 days is unrelated to the surgery.
So, in this case, again add modifier 79 for payment, full payment. And notice that the diagnosis is not the same as the diagnosis for the TURP. The TURP was 6004 and 01 BPH with obstruction. The ICD-9 diagnosis for the stent was ureteral calculus 592.1.
Let's look at another scenario, mentioned by our expert in a billing conference, where we're using several modifiers 24, 25 and 79. Three weeks after a radical nephrectomy for renal carcinoma, the patient goes into urinary retention secondary to an enlarged prostate gland.
Can we bill for the services provided within the global – seeing the patient and putting in a catheter when the global of the nephrectomy. And the answer is absolutely, yes. We see the patient for a reason unrelated to as nephrectomy. So, we bill the 99213 with modifier 24 as per the medical coding guidelines.
We also add modifier 25 because he's having a surgical procedure on the same date as an E/M visit, the insertion of the catheter, the 51702. Now, we add the modifier 79 because he is having a surgical procedure that is unrelated to the radical nephrectomy 51702 when he's paid the full amount.
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