Use of Modifier 79

The changes below will start on August 28, 2018.

The American Medical Association (AMA) describes and defines the use of Modifier 79 as follows:

Description: Unrelated procedure or service by the same physician during the postoperative period.

Instructions: This modifier is used when an unrelated procedure or service, by the same physician, is performed during the postoperative period (10- or 90-day global) of the original procedure. A new post-operative period begins when the unrelated procedure is billed.

We follow the American Medical Association coding guidelines and require the use of Modifier 79 to show that the second procedure by the same physician is unrelated to a prior procedure for which the post-operative period has not been completed. The unrelated procedure must be billed on the same date of service or during the post-operative period of the original service.

On August 28, 2018, any procedures appended with Modifier 79 will be denied for inappropriate modifier usage if no other procedure has been billed on either the same date of service or in the post-operative period by the same reporting provider.

Please make sure your staff is familiar with the definition and the correct use of Modifier 79.

Use these resources to learn more about Modifier 79: