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Global Billing: Document ‘Unrelated’ for Modifier 79 Services

Posted on 07. Jan, 2010 by in Hot Coding Topics

MACs are looking for ‘red flags’ to halt additional global period pay

Billing for additional services during a global surgery period is always tricky, but now you can expect special scrutiny for modifier 79 claims.

After the OIG got wind of fraudulent surgery billing with modifier 79 (Unrelated procedure or service by the same physician during the postoperative period), CMS contractors have been on the hunt for modifier 79 abuse. Implement our expert tips below to keep your 79 claims clean.

Obey Global Package Model

The starting point for clean modifier 79 claims is not breaching the global surgical billing concept. Once you understand the global package rules, you’ll know when you have an exception that warrants an additional claim with an appropriate modifier.

Know what’s included: The global package includes the preoperative visit the day before surgery, intraoperative services, postsurgical complications, and postoperative visits during the global period. It also includes post-surgical pain management services by the surgeon, and miscellaneous services such as dressing changes,...

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