tci Medicare Compliance & Reimbursement - 2009 Issue 4

MODIFIERS: Clear Up Modifier 79 Confusion

Here's how to report modifier 79 the right way. CMS wants to make it crystal clear: If you are reporting modifier 79 (Unrelated procedure or service by the same physician during the postoperative period), your claims better be airtight. On Feb. 13, CMS issued a transmittal that advised contractors to "strengthen program safeguards to prevent improper payment for modifier 79." This came on the heels of an OIG report indicating that modifier 79 had a vast potential for fraud. One of the most common modifier 79 mistakes happens when you try to determine a procedure's relation to the...

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