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Young Ophthalmologists
Misuse of Modifier -79
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The Office of the Inspector General (OIG) recently issued a Management Implication Report on the misuses of the modifier -79.

Modifier -79: Unrelated procedure by the same physician during the postoperative period.

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The CMS global surgical package was established to ensure that all of the components of surgery (including pre- and postoperative services) are included in the surgical payment.

Modifier -79 should be used to indicate that services provided to a patient during the post-op period are unrelated to the global surgical period. Just because there is a new diagnosis code that differs from the surgical code, it does not guarantee that the procedure is unrelated.

Inappropriate use of modifier -79:

  • The procedure performed is related to the original procedure. If the procedure is related, it is considered part of the global period.
  • The procedure performed is actually a staged procedure, which is an appropriate use of modifier -58.

Related Reading
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About the author: This article originally appeared in AAOE’s May 2009 issue of Coding Bulletin.

 
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