# Modifier 58 - I need some clarity



## tnapora (Apr 22, 2009)

Help...  I need some clarity on this.  My surgeon did a lapband procedure.  During the global period he wants us to bill for the first adjustment, using the modifier 58.  The procedure code is S2083.  My question is really two parted.  First, can you even us a modifier on a HCPCs code?  Two, is the adjustment included in the global fee.  I understand the surgeons rationale, this is a planned procedure.  I just feel funny about billing this way.  
I would really appreciate it if someone could shed some light.  

Thank you


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## cedwards (Apr 22, 2009)

I have almost the same question.  I always thought if the fill was performed during the 90 day global period that it was included and not seperately billable.  I was doing some research and found this...

**The majority of bariatric surgical procedures have a 90-day post-op period**
Any E&M services unrelated to the initial procedure may be billed within the post-op period, if appended with modifier 24. (i.e. band adjustments, abscess)

Band adjustments are very common during the post-operative period, sometimes even within the first month following surgery. These visits should be billed with a 24 modifier.

Coding Example: 

99214-2425 Office visit during PONC period 
10022 FNA w/guidance (for adjustment) 
76942 Radiological guidance 
A4209 Needle syringe 
J7050 Saline solution 
(common reason: dysphagia/difficulty swallowing) 

From:  http://www.supmedmgmt.com/medical-gastric-bypass-coding.php 

I don't know how I feel about billing adjustments during the global period.  We use S2083 for the adjustment of the bands. 

Any advice???


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## tnapora (Apr 24, 2009)

*Found my anwser*

Well if it were a snake, it would have bit me by now.  It states right in the CPT book that Adjustments in the global period are considered typical follow-up care in the global period.  So there is not Billing for adjustments.  

This is what CPT states...

Adjustments during the global are bundled and not reported separate. Per CPT Guidelines:

Typical postoperative follow-up care (see Surgery Guidelines, CPT Surgical Package Definition) after gastric restriction using the adjustable gastric restrictive device includes subsequent restrictive device adjustment(s) through the postoperative period for the typical patient. Adjustment consists of changing the gastric restrictive device component diameter by injection or aspiration of fluid through the subcutaneous port component.

Hope this helps everyone.  I should have just READ!!!


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