CPT Modifier 79


Description
CPT® Modifier 79 refers to an unrelated procedure or service by the same physician during the postoperative period.

Guidelines and 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 whether the 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. For E/M services performed in the global period of a surgery, refer to CPT modifiers 24, 25 and 57. 
  • 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.  

Do not submit this modifier on assistant surgery services because global surgery rules do not apply to assistants. Services submitted with HCPCS modifier AS or CPT modifier 80, 81 or 82 in addition to this modifier will be "returned as unprocessable" with remark code MA130. This modifier should be removed and the service(s) resubmitted with HCPCS modifier AS or CPT modifier 80, 81, or 82.

To determine the global period of a surgery, refer to the Medicare Physician Fee Schedule Database (MPFSDB):

  • Access the database directly from the CMS website
    • Select Physician Fee Schedule Search from the bottom of the web page
    • Screen defaults to current year. Under "Type of Information," select Payment Policy Indicators.
    • Choose a single procedure code, multiple procedure codes or a range of codes, then enter the appropriate code(s)
    • Select modifier (or select "all modifiers")
    • Select Submit
    • Refer to the column heading "Global"
  • 000 corresponds to 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 corresponds to 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 corresponds to major surgery with a one-day preoperative period and 90-day postoperative period included in the fee schedule payment amount
  • MMM corresponds to maternity codes. The usual global period does not apply.
  • XXX corresponds to global concept does not apply
  • YYY corresponds to  Palmetto GBA will determine whether the global concept applies and establish a postoperative period, if appropriate
  • ZZZ corresponds to 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 performed on April 25. On June 25 (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 and HCPCS modifier LT, since the second surgery was for treatment of a different eye.
  • Example 2: A right inguinal hernia repair (CPT 49505, 90 global days) was performed on March 24. On April 24, (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 area, even though they are on the same side of the body. 

In some cases (although seldom) 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.

References





Last Updated: 08/02/2021