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/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

Resource

• CMS Internet Only Manual (IOM), Publication 100-04, Medicare Claims Processing Manual, Chapter 4, Section 20.6