tci Part B Insider - 2009 Issue 15

GLOBAL SURGERY: Watch Those Modifier 79 Claims, One MAC Advises

Remember: Medicare only pays for surgical complications during the global if they require a return to the OR. Many aspects of global surgery billing can trip up even the most experienced coder --but its the use of modifier 79 that has the OIGs radar beeping. Last month, the OIG issued a management implication report on the misuse of modifier 79 (Unrelated procedure or service by the same physician during the postoperative period) in change request 6334 (www.cms.hhs.gov/transmittals/downloads/R442OTN.pdf). What happened was, the OIG got wind of some abusive practices happening with this modifier, and the investigation...

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