Modifier 79: Appropriate Use
Modifier 79: Unrelated Procedure
Unrelated procedure or service by the same physician during the postoperative period. 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.
Modifier 79 is appended to a procedure code to indicate that the service is an unrelated procedure that was performed by the same physician during a post-operative period.
- 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 un-processable’ (rejected with remark code MA130). Resubmit these claims with the appropriate assistant-at-surgery CPT modifier (80-82) only.
Examples of Modifier 79
Provider performs right toe amputation on May 24, 2019. On June 25, 2019, a left foot amputation surgery was medically necessary within this 90-day global period. Accurate coding would be: Amputation big toe, RT (28820 TA) and Amputation foot, LT (28800 79)
A right cataract extraction (CPT code 66984, 90 global days) was performed 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.
A right inguinal hernia repair (CPT code 49505, 90 global days) was performed on March 24, 2019. On April 24, 2019, (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.
CPTs and Modifiers © Copyright 2021 American Medical Association
Unfortunately, not all insurers will pay you for the separate E/M service even if you code in compliance with CPT rules. Be sure to have your staff appeal any denied or bundled claims. A review of your documentation by the insurer may actually result in payment for your work. Still, confused after reading examples for modifer 79? Don’t worry E2E Medical Billing Services has an experienced coding team that uses exact modifiers to avoid denials. To know more about our medical billing services call us at 888-552-1290 or write to us at [email protected]