58 - JF Part B
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 Tue, 25 Oct 2022 14:31:49 +0000