Palmetto GBA: , CPT Modifier 79


Description:
Unrelated procedure or service by the same physician during the postoperative period

Guidelines/Instructions:
Submit this modifier when an unrelated subsequent surgery is performed by the same surgeon within the global period of a major or minor surgery, regardless of whetherthe subsequent surgery required a return to the operating room. If a less extensive procedure fails and a more extensive procedure is required, the second procedure is payable separately if CPT modifier 79 is submitted.
  • This modifier may only be submitted with surgery codes
  • No additional documentation is required with the claim. Supporting documentation must be maintained in the patient's medical record. The documentation must substantiate that the surgeries are unrelated.
  • If the subsequent surgery is related to the initial surgery and required a return to the operating room, and both are performed by the same surgeon, refer to CPT modifier 78
  • If the subsequent surgery is related to the initial surgery but does not require a return to the operating room and both are performed by the same surgeon, the subsequent surgery cannot be submitted separately. The global fee for the initial surgery includes additional related surgical procedures that do not require a return to the operating room.
  • E/M services on the same day as a procedure with 0 or 10 global days are generally not payable separately from the procedure. For additional information, please refer to CPT modifier 25.
  • E/M services on the day of the procedure and during this 10-day postoperative period are generally not payable. For additional information, please refer to CPT modifier 57.

Do not submit this modifier with assistant surgery services because global surgery rules do not apply to assistants. Services submitted with CPT modifier 80-82 in addition to CPT Modifier 79 will be 'returned as unprocessable' (rejected with remark code MA130). Resubmit these claims with the appropriate assistant-at-surgey CPT mdofier (80-82) only.

To determine the global period of a surgery, refer to the Medicare Physician Fee Schedule database (MPFSDB):
  • Access the database directly from the CMS Web site at www.cms.gov/PFSlookup/
  • Select Physician Fee Schedule Search from the left area of the Web page
  • Screen defaults to current year. Under Type of Information, select Payment Policy Indicators, then 'next'
  • On the 'select field options' screen, select 'Next'
  • Enter the procedure code and select 'All Modifiers', then click 'Submit'
  • Refer to the column heading 'Global'
  • 000 = Endoscopic or minor procedure with related preoperative and postoperative relative value units on the day of the procedure only, included in the fee schedule payment amount
  • 010 = Minor procedure with preoperative relative values on the day of the procedure and postoperative values during a 10-day postoperative period included in the fee schedule amount
  • 090 = Major surgery with a one-day preoperative period and 90-day postoperative period included in the fee schedule payment amount
  • MMM = Maternity codes. The usual global period does not apply.
  • XXX = Global concept does not apply
  • YYY = Palmetto GBA will determine whether the global concept applies and establish a postoperative period, if appropriate
  • ZZZ = Code is related to another service ('add-on' code) and is always included in the global period of the other service

Examples for Correct Submission of CPT Modifier 79:

  • Example 1: A right cataract extraction (CPT code 66984, 90 global days) was perofmed on April 25, 2009. On June 25, 2009, (within the global period of the previous surgery) a left cataract extraction (CPT code 66984, unrelated to the second surgery) was performed. Submit CPT code 66984 with CPT modifier 79, since the second surgery was for treatment of a different eye.
  • Example 2: A right inguinal hernia repair (CPT code 49505, 90 global days) was performed on March 24, 2009. On April 24, 2009, (within the global period of the previous surgery) a right femoral hernia repair (CPT code 49550) was performed. Submit CPT code 49550 with CPT modifier 79 and HCPCS modifier RT, since the procedures involve hernias from different areas even though they are on the same side of the body.
Seldom, but in some cases, the second surgery performed is inadvertently submitted to Medicare and paid before the first surgery is submitted to Medicare. In this situation, the CPT modifier 79 must be submitted with the first surgery performed.

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