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