When is modifier 58 used

Do not use modifier if the physician returns the patient to the OR because of unplanned complications to a procedure. Several hours later, the physician returns the patient to the OR and performs a colonoscopy with electrocautery to control postoperative bleeding.

In this case, append modifier Join HCPro for a minute webcast with step-by-step strategies and tips to reduce denials along with advice to improve Our experts explain what CMS actually says about charging for services in addition to the room rate and provide strategies This follow-up to our popular Injections and Infusions audio conference delves into more coding questions and responds to Store About Us Career Center.

Modifier This circumstance may be reported by adding modifier 58 to the staged or related procedure. This modifier has multiple uses. Some people think that the physician has to specifically state planned stages in order for a procedure to qualify for the 58 modifier. This is not the case. The subsequent procedure can be within a stated plan of care, or it can be implied, executing a more extensive procedure because the original procedure did not achieve the desired outcome as planned.

When this procedure is related to the first and requires the use of an operating or procedure room, it may be reported by adding modifier 78 to the related procedure. Unlike modifiers 58 and 79, 78 may not be performed anywhere but in the O. For example, a patient who is in the post-op period for arthroscopic shoulder surgery may fall and fracture their leg. Care of their leg is unrelated to the global period created by the shoulder surgery and therefore, any procedure for the leg would have a 79 modifier appended.

For therapy following a surgical procedure. If any of these criteria is mentioned, we can use Modifier 59 with CPT codes. In addition, modifier 58 may be utilized if a diagnostic endoscopy results in the decision to perform an open procedure.

I already told before we can get confused with other modifiers while using Modifier Here is the best example for unplanned return of the patient for any related problem of the original procedure. Such cases occur only when patient get some complication from the original procedure. In such cases, we have to use Modifier 78, which is used for unplanned return to the operating room. The procedure should be staged or planned, the used of modifier 58 is not based on the number of visits.

Do not use Modifier 58 or 78 when any diagnostic procedure is turned into an open procedure. In such case, we will code the most complex procedure that is open procedure CPT code. The diagnostic procedure will get included in it. As per NCCI guidelines, if any planned laparoscopic procedure fails and is converted to an open procedure, only the open procedure is separately reported.

Finally, use of Modifier 58 is only within the global period. If the patient does not visit within the global period of the original procedure, use of modifier 58 or 78 is not appropriate. Read also: Best books for Coding Certification exams for coders. Example 1. A patient has Central Venous catheter placed in Chest.

The Catheter has after few days gets malfunctioned.