Distinguish Modifiers 58 and 78 And Solve Your Reimbursement Woes
Posted on 06. May, 2012 by dchandhok in Hot Coding Topics
Keeping track of global-period modifiers can be confusing , but taking the time to learn about the different modifiers and ensuring that you’re using the correct ones in the right situations is key to correct payment. That’s because one modifier restarts the global period, while another does not, thus impacting your reimbursement rates.
The following modifiers have similar definitions, sharing the words “related procedure” and “during the postoperative period”:
- 58 — Staged or related procedure or service by the same physician during the postoperative period
- 78 — Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period.
The similarities leave many coders and billers scratching their heads. Follow our three expert tips to make sure you pick the right modifier every time.
Tip 1: Reserve 58 for ‘Same Condition’
You should only use modifier 58 when the follow up procedure during the postoperative period arises because of the same condition/problem that prompted the initial procedure. Whether planned or not, the second procedure is the second “stage” of the overall treatment for the original condition.
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According to CMS guidelines, you should use modifier 58 when a subsequent procedure in the postoperative period of the first surgery is:
- planned or “staged” or
- more extensive than the original procedure; or
- for therapy following a surgical procedure; or
- for the reapplication of the cast within the 90-day global period.
Often, your surgeon will document each stage of the surgery, including plans for returning the patient...
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