Modifier 58

Staged or Related Procedure or Service During Postoperative Period by Same Physician

Instructions

  • The same physician planned, at time of original surgery/procedure, a return trip to operating or procedure room within 10 or 90 day post op days

Correct Use

  • Treatment of problem requiring a return to operating/procedure room
    • More extensive than original procedure
    • Unanticipated clinical condition
    • Therapy following a diagnostic, surgical procedure                                
  • Each case requires surgical documentation and evaluation
  • Modifier 58 appropriate for example; hardware removal was planned as part of therapeutic approach involving multiple, staged procedures to the surgical intervention
  • Physicians in same specialty, same group are to bill and are reimbursed as a single physician
  • Use modifier 78 for treatment problems unplanned requiring return trip to operating room
    • If hardware removed in unplanned surgery return for a complication, (e.g. infection of the wound site or rejection of the hardware itself), modifier 78 appropriate

Incorrect Use

  • Not appropriate for E/M or assistant surgery services

Claim Coding Example

  • Patient has excision (CPT 11606) with a 10 day global and a complex repair closure (CPT 13101) planned 9 days after surgical date, append modifier 58 to closure
Treatment Description CPT/Modifier
Excision, malignant lesion trunk, arm, legs 11606
Repair closure 13101 58

 

Resource

 

Last Updated Feb 12, 2020