This coding tip is based on recent findings for claims processed with modifier 79 during a postoperative period.  Current Procedural Terminology (CPT®) specifically states modifier 79 should be reported by the same individual when reporting unrelated procedures or services during the postoperative period. For example, this modifier is used when a patient presents with a problem that is unrelated to a previous surgery (yet within the postoperative period) and requires additional services by the same provider/individual.  When modifier 79 is appended for a different provider (e.g. nurse practitioner or physician assistant) during the postoperative period the claim line will deny.

 

In addition to modifier 79, modifiers 58 and 78 are also based on same physician or other qualified health care professional as documented below:

 

  • 58 – Staged/Related Procedure/Service by the Same Physician/Other Qualified Health Care Professional during the Postoperative Period.
  • 78 – Unplanned Procedure/Service by Same Physician/Other Qualified Health Care Professional Following Initial Procedure for a Related Procedure during the Postoperative Period.

 



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December 2018 Anthem Connecticut Provider Newsletter