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modifier 76 or 79

Mike Posted Tue 01st of March, 2016 12:16:58 PM

Patient had a SCS stim procedure 63650 and it was stopped due to excessive bleeding. Procedure was billed with modifier 53.
A week later the provider performed the tried the procedure again and it was successful. This is still in the global period from the other failed procedure a week ago.
Now do we bill the procedure 63650 with modifier 76 or 79?

SuperCoder Answered Wed 02nd of March, 2016 09:26:35 AM

Hi,

I think modifier 78, because the doctor didn't plan on doing another procedure within week? If it was planned or staged then 58 would be appropriate, otherwise use 78 for an unplanned return to OR for a related procedure. For modifier 58 the global the global resets, but for 78 it does not. This is because 78 is usually used when you have to go back and fix something. but for 78 it does not.

As per guideline, modifier -76 has no follow-up days. It should be used if repeat procedure is being performed on the same day itself. If it is within the global, I don’t think you can use same CPT with modifier -76.

While modifier 79 is for unrelated procedure. If physician has documented that procedure will be repeated after 1 week than modifier 58 is the best option.

Thanks

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