Donna Posted Mon 24th of October, 2016 11:13:38 AM
Once the fracture care has been billed and the patient returns for a follow up and the casts is changed, do you need to put a modifier 79 on the cast application to protect since you are in the global for the fracture care?
SuperCoder Answered Tue 25th of October, 2016 02:17:33 AM
Modifier 79 represents "Unrelated Procedure or Service by the Same Physician or Other Qualified Health Care Professional During the Postoperative Period". However, the above documentation indicates that Cast was re-applied for the very same diagnosis or condition (changing from Intial to Subsequent encounter, but the condition is still same). So, for these type of scenerio, if Cast is re-applied, you need to append modifier -58 (Staged or Related Procedure or Service by the Same Physician or Other Qualified Health Care Professional During the Postoperative Period) on Cast application CPT code. Also, please provide the documentation to support the medical necessity of re-application of cast.