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69930-79 for billing Medicare

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  • charmaine munt
    List, Good morning, I need some insight regarding the appropriate utilization of the 79 modifier with CPT 69930 (cochlear implant). If a patient has been
    Message 1 of 10 , Feb 2, 2012
      List,

      Good morning,



      I need some insight regarding the appropriate utilization of the 79 modifier
      with CPT 69930 (cochlear implant). If a patient has been preauthorized for
      a bilateral cochlear implant and the second implant is done within the 90
      day global period would the application of the 79 modifier be appropriate??
      79- Unrelated Procedure or Service by the same Physician During the
      Postoperative Period. Any source document is appreciated as this question
      in relation to CMS as we all know the commercial payers may all have varying
      guidelines. Thank you in advance and have a great day!!!



      Kind regards,



      Charmaine Munt



      MAKE IT A GREAT DAY!!!











      [Non-text portions of this message have been removed]
    • cathycpc7200@aol.com
      Look at modifier 58. Cathy Karas, CPC In a message dated 2/2/2012 10:56:13 A.M. Central Standard Time, charmainek@earthlink.net writes: List, Good morning, I
      Message 2 of 10 , Feb 2, 2012
        Look at modifier 58.

        Cathy Karas, CPC


        In a message dated 2/2/2012 10:56:13 A.M. Central Standard Time,
        charmainek@... writes:




        List,

        Good morning,

        I need some insight regarding the appropriate utilization of the 79
        modifier
        with CPT 69930 (cochlear implant). If a patient has been preauthorized for
        a bilateral cochlear implant and the second implant is done within the 90
        day global period would the application of the 79 modifier be appropriate??
        79- Unrelated Procedure or Service by the same Physician During the
        Postoperative Period. Any source document is appreciated as this question
        in relation to CMS as we all know the commercial payers may all have
        varying
        guidelines. Thank you in advance and have a great day!!!

        Kind regards,

        Charmaine Munt

        MAKE IT A GREAT DAY!!!

        [Non-text portions of this message have been removed]






        [Non-text portions of this message have been removed]
      • John E. Slater
        Modifier 79 Fact Sheet Definition a.. Unrelated procedure by the same physician during the post-operative period Appropriate Usage a.. To describe an unrelated
        Message 3 of 10 , Feb 2, 2012
          Modifier 79 Fact Sheet
          Definition
          a.. Unrelated procedure by the same physician during the post-operative period
          Appropriate Usage
          a.. To describe an unrelated procedure performed during the post-operative period of the original procedure.
          b.. The two procedures are performed by the same physician
          c.. All procedure codes except those with XXX in the GLOB (global) field of the MPFSDB.
          d.. Used on services during the post-operative period starting the day after the procedure
          Inappropriate Usage
          a.. The procedure performed is related to the original procedure or a staged procedure.
          b.. If the services performed are related to the original procedure, it is considered part of the global period.
          Modifier 58 Fact Sheet
          Definition
          a.. Indicates a staged or related procedure or service by the same physician* during the postoperative period
          Appropriate Usage
          a.. To report a staged procedure planned at the time of the original procedure
          b.. When the staged procedure is more extensive than the original procedure
          c.. For therapy following a diagnostic surgical procedure
          d.. When performing a second or related procedure during the postoperative period.
          Inappropriate Usage
          a.. Appending the modifier to ASC facility fee claims
          b.. Appending the modifier to a procedure with XXX global period on the MPFSDB
          c.. Appending the modifier to services listed in CPT as multiple sessions, (i.e. 67208, Destruction of localized lesion of retina, one or more sessions)
          d.. Reporting the treatment of a complication from the original surgery:
          a.. That requires a return trip to the operating room (See Modifier 78 fact sheet)
          b.. That does not require a return trip to the operating room (service not separately payable.
          e.. Unrelated procedures during the postoperative period
          Facts
          a.. A new postoperative period begins when the next procedure in the staged procedure series is billed.
          b.. Staged procedures do not apply to claims for assistant at surgery or services of an ASC.
          c.. Used during the post-operative period starting the day after the initial procedure.
          Same Physician - Medicare regulation states: "Physicians in the same group practice who are in the same specialty must bill and be paid as though they were a single physician." The same physician concept also applies when the exact same physician performs services.

          ----- Original Message -----
          From: cathycpc7200@...
          To: CRN-L@yahoogroups.com
          Sent: Thursday, February 02, 2012 12:14 PM
          Subject: Re: [CRN-L] 69930-79 for billing Medicare



          Look at modifier 58.

          Cathy Karas, CPC


          In a message dated 2/2/2012 10:56:13 A.M. Central Standard Time,
          charmainek@... writes:

          List,

          Good morning,

          I need some insight regarding the appropriate utilization of the 79
          modifier
          with CPT 69930 (cochlear implant). If a patient has been preauthorized for
          a bilateral cochlear implant and the second implant is done within the 90
          day global period would the application of the 79 modifier be appropriate??
          79- Unrelated Procedure or Service by the same Physician During the
          Postoperative Period. Any source document is appreciated as this question
          in relation to CMS as we all know the commercial payers may all have
          varying
          guidelines. Thank you in advance and have a great day!!!

          Kind regards,

          Charmaine Munt

          MAKE IT A GREAT DAY!!!

          [Non-text portions of this message have been removed]

          [Non-text portions of this message have been removed]





          [Non-text portions of this message have been removed]
        • charmaine munt
          Cathy, Thank you, The second procedure needs to be more extensive that the first to use the 58 and the procedure in this case would be the same. Kind regards,
          Message 4 of 10 , Feb 2, 2012
            Cathy,



            Thank you, The second procedure needs to be more extensive that the first to
            use the 58 and the procedure in this case would be the same.



            Kind regards,



            Charmaine Munt



            MAKE IT A GREAT DAY!!!







            _____

            From: CRN-L@yahoogroups.com [mailto:CRN-L@yahoogroups.com] On Behalf Of
            cathycpc7200@...
            Sent: Thursday, February 02, 2012 11:14 AM
            To: CRN-L@yahoogroups.com
            Subject: Re: [CRN-L] 69930-79 for billing Medicare





            Look at modifier 58.

            Cathy Karas, CPC


            In a message dated 2/2/2012 10:56:13 A.M. Central Standard Time,
            charmainek@... <mailto:charmainek%40earthlink.net> writes:

            List,

            Good morning,

            I need some insight regarding the appropriate utilization of the 79
            modifier
            with CPT 69930 (cochlear implant). If a patient has been preauthorized for
            a bilateral cochlear implant and the second implant is done within the 90
            day global period would the application of the 79 modifier be appropriate??
            79- Unrelated Procedure or Service by the same Physician During the
            Postoperative Period. Any source document is appreciated as this question
            in relation to CMS as we all know the commercial payers may all have
            varying
            guidelines. Thank you in advance and have a great day!!!

            Kind regards,

            Charmaine Munt

            MAKE IT A GREAT DAY!!!

            [Non-text portions of this message have been removed]

            [Non-text portions of this message have been removed]





            [Non-text portions of this message have been removed]
          • charmaine munt
            John, Thank you, where is this information from?? Kind regards, Charmaine Munt MAKE IT A GREAT DAY!!! _____ From: CRN-L@yahoogroups.com
            Message 5 of 10 , Feb 2, 2012
              John,

              Thank you, where is this information from??



              Kind regards,



              Charmaine Munt



              MAKE IT A GREAT DAY!!!







              _____

              From: CRN-L@yahoogroups.com [mailto:CRN-L@yahoogroups.com] On Behalf Of John
              E. Slater
              Sent: Thursday, February 02, 2012 11:43 AM
              To: CRN-L@yahoogroups.com
              Subject: Re: [CRN-L] 69930-79 for billing Medicare





              Modifier 79 Fact Sheet
              Definition
              a.. Unrelated procedure by the same physician during the post-operative
              period
              Appropriate Usage
              a.. To describe an unrelated procedure performed during the post-operative
              period of the original procedure.
              b.. The two procedures are performed by the same physician
              c.. All procedure codes except those with XXX in the GLOB (global) field of
              the MPFSDB.
              d.. Used on services during the post-operative period starting the day after
              the procedure
              Inappropriate Usage
              a.. The procedure performed is related to the original procedure or a staged
              procedure.
              b.. If the services performed are related to the original procedure, it is
              considered part of the global period.
              Modifier 58 Fact Sheet
              Definition
              a.. Indicates a staged or related procedure or service by the same
              physician* during the postoperative period
              Appropriate Usage
              a.. To report a staged procedure planned at the time of the original
              procedure
              b.. When the staged procedure is more extensive than the original procedure
              c.. For therapy following a diagnostic surgical procedure
              d.. When performing a second or related procedure during the postoperative
              period.
              Inappropriate Usage
              a.. Appending the modifier to ASC facility fee claims
              b.. Appending the modifier to a procedure with XXX global period on the
              MPFSDB
              c.. Appending the modifier to services listed in CPT as multiple sessions,
              (i.e. 67208, Destruction of localized lesion of retina, one or more
              sessions)
              d.. Reporting the treatment of a complication from the original surgery:
              a.. That requires a return trip to the operating room (See Modifier 78 fact
              sheet)
              b.. That does not require a return trip to the operating room (service not
              separately payable.
              e.. Unrelated procedures during the postoperative period
              Facts
              a.. A new postoperative period begins when the next procedure in the staged
              procedure series is billed.
              b.. Staged procedures do not apply to claims for assistant at surgery or
              services of an ASC.
              c.. Used during the post-operative period starting the day after the initial
              procedure.
              Same Physician - Medicare regulation states: "Physicians in the same group
              practice who are in the same specialty must bill and be paid as though they
              were a single physician." The same physician concept also applies when the
              exact same physician performs services.

              ----- Original Message -----
              From: cathycpc7200@... <mailto:cathycpc7200%40aol.com>
              To: CRN-L@yahoogroups.com <mailto:CRN-L%40yahoogroups.com>
              Sent: Thursday, February 02, 2012 12:14 PM
              Subject: Re: [CRN-L] 69930-79 for billing Medicare

              Look at modifier 58.

              Cathy Karas, CPC

              In a message dated 2/2/2012 10:56:13 A.M. Central Standard Time,
              charmainek@... <mailto:charmainek%40earthlink.net> writes:

              List,

              Good morning,

              I need some insight regarding the appropriate utilization of the 79
              modifier
              with CPT 69930 (cochlear implant). If a patient has been preauthorized for
              a bilateral cochlear implant and the second implant is done within the 90
              day global period would the application of the 79 modifier be appropriate??
              79- Unrelated Procedure or Service by the same Physician During the
              Postoperative Period. Any source document is appreciated as this question
              in relation to CMS as we all know the commercial payers may all have
              varying
              guidelines. Thank you in advance and have a great day!!!

              Kind regards,

              Charmaine Munt

              MAKE IT A GREAT DAY!!!

              [Non-text portions of this message have been removed]

              [Non-text portions of this message have been removed]

              [Non-text portions of this message have been removed]





              [Non-text portions of this message have been removed]
            • John E. Slater
              the link is below http://www.wpsmedicare.com/part_b/resources/modifiers/modifier-58.shtml ... From: charmaine munt To: CRN-L@yahoogroups.com Sent: Thursday,
              Message 6 of 10 , Feb 2, 2012
                the link is below

                http://www.wpsmedicare.com/part_b/resources/modifiers/modifier-58.shtml


                ----- Original Message -----
                From: charmaine munt
                To: CRN-L@yahoogroups.com
                Sent: Thursday, February 02, 2012 1:02 PM
                Subject: RE: [CRN-L] 69930-79 for billing Medicare



                John,

                Thank you, where is this information from??

                Kind regards,

                Charmaine Munt

                MAKE IT A GREAT DAY!!!

                _____

                From: CRN-L@yahoogroups.com [mailto:CRN-L@yahoogroups.com] On Behalf Of John
                E. Slater
                Sent: Thursday, February 02, 2012 11:43 AM
                To: CRN-L@yahoogroups.com
                Subject: Re: [CRN-L] 69930-79 for billing Medicare

                Modifier 79 Fact Sheet
                Definition
                a.. Unrelated procedure by the same physician during the post-operative
                period
                Appropriate Usage
                a.. To describe an unrelated procedure performed during the post-operative
                period of the original procedure.
                b.. The two procedures are performed by the same physician
                c.. All procedure codes except those with XXX in the GLOB (global) field of
                the MPFSDB.
                d.. Used on services during the post-operative period starting the day after
                the procedure
                Inappropriate Usage
                a.. The procedure performed is related to the original procedure or a staged
                procedure.
                b.. If the services performed are related to the original procedure, it is
                considered part of the global period.
                Modifier 58 Fact Sheet
                Definition
                a.. Indicates a staged or related procedure or service by the same
                physician* during the postoperative period
                Appropriate Usage
                a.. To report a staged procedure planned at the time of the original
                procedure
                b.. When the staged procedure is more extensive than the original procedure
                c.. For therapy following a diagnostic surgical procedure
                d.. When performing a second or related procedure during the postoperative
                period.
                Inappropriate Usage
                a.. Appending the modifier to ASC facility fee claims
                b.. Appending the modifier to a procedure with XXX global period on the
                MPFSDB
                c.. Appending the modifier to services listed in CPT as multiple sessions,
                (i.e. 67208, Destruction of localized lesion of retina, one or more
                sessions)
                d.. Reporting the treatment of a complication from the original surgery:
                a.. That requires a return trip to the operating room (See Modifier 78 fact
                sheet)
                b.. That does not require a return trip to the operating room (service not
                separately payable.
                e.. Unrelated procedures during the postoperative period
                Facts
                a.. A new postoperative period begins when the next procedure in the staged
                procedure series is billed.
                b.. Staged procedures do not apply to claims for assistant at surgery or
                services of an ASC.
                c.. Used during the post-operative period starting the day after the initial
                procedure.
                Same Physician - Medicare regulation states: "Physicians in the same group
                practice who are in the same specialty must bill and be paid as though they
                were a single physician." The same physician concept also applies when the
                exact same physician performs services.

                ----- Original Message -----
                From: cathycpc7200@... <mailto:cathycpc7200%40aol.com>
                To: CRN-L@yahoogroups.com <mailto:CRN-L%40yahoogroups.com>
                Sent: Thursday, February 02, 2012 12:14 PM
                Subject: Re: [CRN-L] 69930-79 for billing Medicare

                Look at modifier 58.

                Cathy Karas, CPC

                In a message dated 2/2/2012 10:56:13 A.M. Central Standard Time,
                charmainek@... <mailto:charmainek%40earthlink.net> writes:

                List,

                Good morning,

                I need some insight regarding the appropriate utilization of the 79
                modifier
                with CPT 69930 (cochlear implant). If a patient has been preauthorized for
                a bilateral cochlear implant and the second implant is done within the 90
                day global period would the application of the 79 modifier be appropriate??
                79- Unrelated Procedure or Service by the same Physician During the
                Postoperative Period. Any source document is appreciated as this question
                in relation to CMS as we all know the commercial payers may all have
                varying
                guidelines. Thank you in advance and have a great day!!!

                Kind regards,

                Charmaine Munt

                MAKE IT A GREAT DAY!!!

                [Non-text portions of this message have been removed]

                [Non-text portions of this message have been removed]

                [Non-text portions of this message have been removed]

                [Non-text portions of this message have been removed]





                [Non-text portions of this message have been removed]
              • mmsnyrobi@aol.com
                Charmaine, I have a question regarding your inquiry. “If a patient has been preauthorized for a bilateral cochlear implant and the second implant is done
                Message 7 of 10 , Feb 2, 2012
                  Charmaine,

                  I have a question regarding your inquiry. “If a patient has been preauthorized for
                  a bilateral cochlear implant and the second implant is done within the 90
                  day global period would the application of the 79 modifier be appropriate? Why would you consider this unrelated if the preauthorization was for a bilateral service? I would think that the 58 modifier would be most appropriate. The service should be reported as a staged procedure because the provider knew in advance that a second surgery would be required when obtaining the preauthorization.

                  Have a Blessed Day!

                  Sheila C. Dwyer


                  From: charmaine munt
                  Sent: Thursday, February 02, 2012 11:31 AM
                  To: CRN-L@yahoogroups.com ; 'Multiple recipients of list PARTB-L'
                  Subject: [CRN-L] 69930-79 for billing Medicare


                  List,

                  Good morning,

                  I need some insight regarding the appropriate utilization of the 79 modifier
                  with CPT 69930 (cochlear implant). If a patient has been preauthorized for
                  a bilateral cochlear implant and the second implant is done within the 90
                  day global period would the application of the 79 modifier be appropriate??
                  79- Unrelated Procedure or Service by the same Physician During the
                  Postoperative Period. Any source document is appreciated as this question
                  in relation to CMS as we all know the commercial payers may all have varying
                  guidelines. Thank you in advance and have a great day!!!

                  Kind regards,

                  Charmaine Munt

                  MAKE IT A GREAT DAY!!!

                  [Non-text portions of this message have been removed]





                  [Non-text portions of this message have been removed]
                • charmaine munt
                  Shelia, one of the criteria for the 58 modifier is that the second procedure is more extensive than the first so in this case the procedures are the same- if
                  Message 8 of 10 , Feb 2, 2012
                    Shelia, one of the criteria for the 58 modifier is that the second procedure
                    is more extensive than the first so in this case the procedures are the
                    same- if there is a different interpretation of this I am certainly
                    interested in understanding it- Thank you



                    Kind regards,



                    Charmaine Munt



                    MAKE IT A GREAT DAY!!!







                    _____

                    From: CRN-L@yahoogroups.com [mailto:CRN-L@yahoogroups.com] On Behalf Of
                    mmsnyrobi@...
                    Sent: Thursday, February 02, 2012 6:12 PM
                    To: CRN-L@yahoogroups.com
                    Subject: Re: [CRN-L] 69930-79 for billing Medicare





                    Charmaine,

                    I have a question regarding your inquiry. "If a patient has been
                    preauthorized for
                    a bilateral cochlear implant and the second implant is done within the 90
                    day global period would the application of the 79 modifier be appropriate?
                    Why would you consider this unrelated if the preauthorization was for a
                    bilateral service? I would think that the 58 modifier would be most
                    appropriate. The service should be reported as a staged procedure because
                    the provider knew in advance that a second surgery would be required when
                    obtaining the preauthorization.

                    Have a Blessed Day!

                    Sheila C. Dwyer

                    From: charmaine munt
                    Sent: Thursday, February 02, 2012 11:31 AM
                    To: CRN-L@yahoogroups.com <mailto:CRN-L%40yahoogroups.com> ; 'Multiple
                    recipients of list PARTB-L'
                    Subject: [CRN-L] 69930-79 for billing Medicare

                    List,

                    Good morning,

                    I need some insight regarding the appropriate utilization of the 79 modifier
                    with CPT 69930 (cochlear implant). If a patient has been preauthorized for
                    a bilateral cochlear implant and the second implant is done within the 90
                    day global period would the application of the 79 modifier be appropriate??
                    79- Unrelated Procedure or Service by the same Physician During the
                    Postoperative Period. Any source document is appreciated as this question
                    in relation to CMS as we all know the commercial payers may all have varying
                    guidelines. Thank you in advance and have a great day!!!

                    Kind regards,

                    Charmaine Munt

                    MAKE IT A GREAT DAY!!!

                    [Non-text portions of this message have been removed]

                    [Non-text portions of this message have been removed]





                    [Non-text portions of this message have been removed]
                  • mmsnyrobi@aol.com
                    Charmaine, The 58 modifier would be your best choice. The criteria specifies a) Planned or anticipated (staged), b) more extensive, or c) for therapy following
                    Message 9 of 10 , Feb 2, 2012
                      Charmaine,

                      The 58 modifier would be your best choice. The criteria specifies a) Planned or anticipated (staged), b) more extensive, or c) for therapy following a surgical procedure. It is not necessary to meet all three categories listed above; The text in the descriptor of the modifier in Appendix A of the CPT utilizes comma’s indicating possible scenarios.

                      You can always append a separate a special report indicating the details as found in the CPT Book under the Surgical Guidelines for “Special Report”. As indicated by the modifier utilization of CPT the criteria has been met for a planned or staged procedure.

                      Remember that each carrier writes their own rules regarding reimbursement. Check your carrier’s policy for any limitations or specifications of coverage.

                      You may also want to ask assistance from your Medical Society on how to code the service.

                      Hope this helps.

                      Sheila

                      From: charmaine munt
                      Sent: Thursday, February 02, 2012 9:26 PM
                      To: CRN-L@yahoogroups.com
                      Subject: RE: [CRN-L] 69930-79 for billing Medicare


                      Shelia, one of the criteria for the 58 modifier is that the second procedure
                      is more extensive than the first so in this case the procedures are the
                      same- if there is a different interpretation of this I am certainly
                      interested in understanding it- Thank you

                      Kind regards,

                      Charmaine Munt

                      MAKE IT A GREAT DAY!!!

                      _____

                      From: mailto:CRN-L%40yahoogroups.com [mailto:mailto:CRN-L%40yahoogroups.com] On Behalf Of
                      mailto:mmsnyrobi%40aol.com
                      Sent: Thursday, February 02, 2012 6:12 PM
                      To: mailto:CRN-L%40yahoogroups.com
                      Subject: Re: [CRN-L] 69930-79 for billing Medicare

                      Charmaine,

                      I have a question regarding your inquiry. "If a patient has been
                      preauthorized for
                      a bilateral cochlear implant and the second implant is done within the 90
                      day global period would the application of the 79 modifier be appropriate?
                      Why would you consider this unrelated if the preauthorization was for a
                      bilateral service? I would think that the 58 modifier would be most
                      appropriate. The service should be reported as a staged procedure because
                      the provider knew in advance that a second surgery would be required when
                      obtaining the preauthorization.

                      Have a Blessed Day!

                      Sheila C. Dwyer

                      From: charmaine munt
                      Sent: Thursday, February 02, 2012 11:31 AM
                      To: mailto:CRN-L%40yahoogroups.com <mailto:CRN-L%40yahoogroups.com> ; 'Multiple
                      recipients of list PARTB-L'
                      Subject: [CRN-L] 69930-79 for billing Medicare

                      List,

                      Good morning,

                      I need some insight regarding the appropriate utilization of the 79 modifier
                      with CPT 69930 (cochlear implant). If a patient has been preauthorized for
                      a bilateral cochlear implant and the second implant is done within the 90
                      day global period would the application of the 79 modifier be appropriate??
                      79- Unrelated Procedure or Service by the same Physician During the
                      Postoperative Period. Any source document is appreciated as this question
                      in relation to CMS as we all know the commercial payers may all have varying
                      guidelines. Thank you in advance and have a great day!!!

                      Kind regards,

                      Charmaine Munt

                      MAKE IT A GREAT DAY!!!

                      [Non-text portions of this message have been removed]

                      [Non-text portions of this message have been removed]

                      [Non-text portions of this message have been removed]





                      [Non-text portions of this message have been removed]
                    • charmaine munt
                      Shelia, Thank you for the information- and I agree with you. I had forgotten about how CPT has this modifier defined. I found an old e mail from Seth
                      Message 10 of 10 , Feb 3, 2012
                        Shelia,

                        Thank you for the information- and I agree with you. I had forgotten about
                        how CPT has this modifier defined. I found an old e mail from Seth stating
                        that there is no source document necessary to validate this as the way the
                        definition is written is the validation. We have reached out to the
                        specialty societies and there is no concrete documentation on coding for
                        bilateral cochlear implants, the initial analysis of the device and
                        subsequent programming. All of this is up to each medical director at the
                        MAC and of course as you state below the commercial payers all have their
                        own criteria. Thanks for the reminder and have a great weekend!!!



                        Kind regards,



                        Charmaine Munt



                        MAKE IT A GREAT DAY!!!







                        _____

                        From: CRN-L@yahoogroups.com [mailto:CRN-L@yahoogroups.com] On Behalf Of
                        mmsnyrobi@...
                        Sent: Thursday, February 02, 2012 11:36 PM
                        To: CRN-L@yahoogroups.com
                        Subject: Re: [CRN-L] 69930-79 for billing Medicare





                        Charmaine,

                        The 58 modifier would be your best choice. The criteria specifies a) Planned
                        or anticipated (staged), b) more extensive, or c) for therapy following a
                        surgical procedure. It is not necessary to meet all three categories listed
                        above; The text in the descriptor of the modifier in Appendix A of the CPT
                        utilizes comma's indicating possible scenarios.

                        You can always append a separate a special report indicating the details as
                        found in the CPT Book under the Surgical Guidelines for "Special Report". As
                        indicated by the modifier utilization of CPT the criteria has been met for a
                        planned or staged procedure.

                        Remember that each carrier writes their own rules regarding reimbursement.
                        Check your carrier's policy for any limitations or specifications of
                        coverage.

                        You may also want to ask assistance from your Medical Society on how to code
                        the service.

                        Hope this helps.

                        Sheila

                        From: charmaine munt
                        Sent: Thursday, February 02, 2012 9:26 PM
                        To: CRN-L@yahoogroups.com <mailto:CRN-L%40yahoogroups.com>
                        Subject: RE: [CRN-L] 69930-79 for billing Medicare

                        Shelia, one of the criteria for the 58 modifier is that the second procedure
                        is more extensive than the first so in this case the procedures are the
                        same- if there is a different interpretation of this I am certainly
                        interested in understanding it- Thank you

                        Kind regards,

                        Charmaine Munt

                        MAKE IT A GREAT DAY!!!

                        _____

                        From: mailto:CRN-L%40yahoogroups.com [mailto:mailto:CRN-L%40yahoogroups.com]
                        On Behalf Of
                        mailto:mmsnyrobi%40aol.com
                        Sent: Thursday, February 02, 2012 6:12 PM
                        To: mailto:CRN-L%40yahoogroups.com
                        Subject: Re: [CRN-L] 69930-79 for billing Medicare

                        Charmaine,

                        I have a question regarding your inquiry. "If a patient has been
                        preauthorized for
                        a bilateral cochlear implant and the second implant is done within the 90
                        day global period would the application of the 79 modifier be appropriate?
                        Why would you consider this unrelated if the preauthorization was for a
                        bilateral service? I would think that the 58 modifier would be most
                        appropriate. The service should be reported as a staged procedure because
                        the provider knew in advance that a second surgery would be required when
                        obtaining the preauthorization.

                        Have a Blessed Day!

                        Sheila C. Dwyer

                        From: charmaine munt
                        Sent: Thursday, February 02, 2012 11:31 AM
                        To: mailto:CRN-L%40yahoogroups.com <mailto:CRN-L%40yahoogroups.com> ;
                        'Multiple
                        recipients of list PARTB-L'
                        Subject: [CRN-L] 69930-79 for billing Medicare

                        List,

                        Good morning,

                        I need some insight regarding the appropriate utilization of the 79 modifier
                        with CPT 69930 (cochlear implant). If a patient has been preauthorized for
                        a bilateral cochlear implant and the second implant is done within the 90
                        day global period would the application of the 79 modifier be appropriate??
                        79- Unrelated Procedure or Service by the same Physician During the
                        Postoperative Period. Any source document is appreciated as this question
                        in relation to CMS as we all know the commercial payers may all have varying
                        guidelines. Thank you in advance and have a great day!!!

                        Kind regards,

                        Charmaine Munt

                        MAKE IT A GREAT DAY!!!

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