07/26/2018

Correct Billing for CPT 10060 and 10061

I performed 10060 on a pt with Empire BC/BS. Six days later, with the paronychia getting worse, I performed 10061. I used the -79- modifier.They refuse to pay, saying it is within the 10 day, aftercare period. HELP!!!!

A corrected claim should be submitted to Empire BC/BS with Modifier 78 (Return to Operating Room for related surgery during post op period) instead of Modifier 79. Since the subsequent I&D was unplanned and related to the initial office procedure performed on the patient, Modifier 79 would be inappropriate and the claim was denied correctly by Blue Cross. Progress notes may need to be submitted to justify the use of the modifier and to prove that the complications from the initial incision and drainage required additional care that should be separate from the global period of the previous visit.