Ask Dr. Z

This is an "appeal to common sense" question. We've reached out to our Carrier, and now I'm inquiring on your thoughts. The new 2014 stent codes (37238/37236) reflect on the CMS RVU table that there is a 000 global period; therefore, a global modifier would be necessary if performed within the global period of another service. Submitting with a global modifier of -78 (related, unplanned procedure) denies the charge for "inconsistent"; however, modifier -79 (unrelated/unplanned) is acceptable. I am using modifier -78 in the context of dialysis graft that declotted patient returns due to a subsequent declot and stent is additionally placed due to persistent recoil. Can you make the case the stent is "unrelated", as the recoil is due to current visit, or related since it is all being performed in dialysis graft?