# Global Period Affected by Modifier 58 or 78?



## sraines

Does using modifier 58 or 78 effect the global period calculation?
Example:  Patient has an open fracture procedure (27244) with 90 global period on 9/9/09, then has subsequent related surgeries for I&D of abscess (27301) or secondary closure (13160) that have 90 day global periods, but were billed with either 58 or 78 modifiers.  Which service do I use to determine when patient is out of global period?


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## RebeccaWoodward*

Modifier 58=The global *period restarts *with the subsequent procedure, and the surgeon should receive 100 percent of the allowable reimbursement on both the first and the subsequent procedures.

http://www.aaos.org/news/aaosnow/may09/managing1.asp


Modifier 78=Conventionally, modifier 78 results in a *decrease* in reimbursement assigned to the “intraoperative” portion of the case. For example, Medicare reduces reimbursement by 69 percent, but other payors may use a different percentage. 

The other issue to remember is that appending modifier 78 to a procedure ties the global period to the *original case*.

http://www.aaos.org/news/aaosnow/sep09/managing5.asp


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## sraines

Thanks!!


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## tgenius1

*CPT Code 15430 - 15431 used for "Wound Care"*

There are some LCD's that states CPT code 15430 - 15431 "will not be paid no more frequently than at 90-day intervals."  Will the 58 modifier be appropriate to add for re-applications of a Skin Substitute within a 90 day interval?

Note:  Treatment of any ulcer will typically last no more than twelve (12) weeks.
The treatment/skin substitute may be applied twice a week within a twelve week period before improvement is seen.


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## vkratzer

I have the same question regarding application of biologic wound dressing (15430).  Can we use the 58 modifier with each application?

Vicky


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## asdaines

*confused *

patient had a deep thigh hematoma that was treated on June 1st by incision and drainage; cpt 27301 was billed.  patient went home, but developed fever and swelling, came back to the hospital and had another 27301 performed on June 7th by the same surgeon.  modifier 78 was applied to the June 7th procedure, my question is simply because modifier 78 does not reset the global period, does that mean the June 7th procedure does not get one at all as a 27301 is a 90 day global procedure?  Any help would be appreciated, I just want to make sure I'm not giving our patients the wrong information and ending their global periods too soon.  Thanks!


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## danskangel313

asdaines said:


> patient had a deep thigh hematoma that was treated on June 1st by incision and drainage; cpt 27301 was billed.  patient went home, but developed fever and swelling, came back to the hospital and had another 27301 performed on June 7th by the same surgeon.  modifier 78 was applied to the June 7th procedure, my question is simply because modifier 78 does not reset the global period, does that mean the June 7th procedure does not get one at all as a 27301 is a 90 day global procedure?  Any help would be appreciated, I just want to make sure I'm not giving our patients the wrong information and ending their global periods too soon.  Thanks!



Modifier 78 ties that return to the OR to the original procedure, so it does not restart the global period nor does it create a new one because of the relationship between the return to the OR and the original procedure - because it's a complication. The key is that it has to be complication, the documentation has to clearly indicate it's a complication, and that it required a return to an actual OR. And as previously mentioned, the reimbursement is reduced.


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