12/07/2023

Correct Billing for Non-Related Visit to a Left Foot Fracture

On September 2,I saw a patient for a left foot fracture;this ICD code was S92.355A.I saw the patient subsequently;of course,since the global period was in play, he(his insurance) was not billed.I saw him December 2 for a different complaint of metatarsalgia.Do I need the 79 modifier here?

The appropriate modifier to use depends on the CPT code billed for a visit not related to the fracture. If an E&M office visit is billed then append modifier -24. If a procedure was performed then append modifier -79.  Only metatarsalgia should be billed on the claim with no mention of the subsequent fracture diagnosis because it’s an unrelated service.