Modifier 58

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

Treatment Description CPT/Modifier
Excision, malignant lesion trunk, arm, legs 11606
Repair closure 13101 58

Resource

Last Updated Nov 11 , 2024