58 - JE Part B

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

Instructions

• The same physician planned, at time of original surgery or procedure days

Correct Use

• Treatment of problem
  • More extensive than original procedure
  • Planned prospectively, or at the time of the original procedure
  • Therapy following a diagnostic, surgical procedure
• Each case requires surgical documentation and evaluation
• Modifier 58 example - hardware removal was planned as part of therapeutic approach involving multiple, staged procedures to surgical intervention
• Physicians in same specialty and group are to bill, and be reimbursed, as a single physician
• See modifier 78 for unplanned return to operating room

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 nine days after surgical date, append modifier 58 to closure

Resource

• CMS Internet Only Manual (IOM), Publication 100-04, Medicare Claims Processing Manual, Chapter 12
• National Correct Coding Initiative (NCCI) Policy Manual, Chapter 1