tci Medicare Compliance & Reimbursement - 2009 Issue 4
MODIFIERS: Clear Up Modifier 79 Confusion
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Article Overview
This article is for coding professionals, billers, and compliance staff who need a clearer understanding of CMS concerns surrounding modifier 79. It summarizes why the modifier has drawn increased attention, references CMS and OIG activity, and discusses the broad circumstances that can create confusion when identifying procedures during the global period. The article is relevant to readers looking for compliance context and high-level guidance on postoperative reporting issues.
Why This Topic Matters
Modifier 79 has been a focus of CMS program safeguards and payment integrity efforts, so understanding the surrounding compliance context can help reduce claim risk and documentation problems.
What You Will Learn
- Why modifier 79 has received increased compliance attention
- What types of postoperative scenarios can create confusion around unrelated services
- How CMS and OIG activity relates to modifier 79 oversight
- What general documentation context may matter when evaluating postoperative reporting
Who Should Read This
- Medical coders
- Billing professionals
- Compliance staff
- Revenue cycle teams
Modifiers Discussed
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