# Modifier  58 or 76 or 78



## sleepycats (Feb 15, 2009)

Hi,

In the ASC arena, a patient came in for a nerve root injection. The MD discussed with the patient the possibility of taking the patient back to the OR to perform an injection at a different level if the first one was not successful. The injection was performed and the patent taken to the recovery room.  After a discussion the the patient in the recovery room, the MD  took the patient back to the OR to perform another injection at a different level.  Which modifier is appropriate and why?

Thanks!!


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## med-biller (Feb 15, 2009)

What were the levels injected and what injection was documented?  Was it a selective nerve root block/transforaminal injection?  If so, I would use 64483 for the first level and 64484 for the 2nd injection.


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## sleepycats (Feb 15, 2009)

If I remember correctly, the first trip to the OR was documented as T10 intercostal nerve (64420) and the second trip was T11 intercostal nerve (64420).


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## jdrueppel (Feb 15, 2009)

If the CPT code 64420 is correct , which I'm questioning because you state "nerve root" injection and 64420 is a relatively non invasive block, then I would use the -76 modifier (repeat procedure).  The -58 and -78 modifiers are not appropriate as CPT 64420 has no global period.  I would also not consider 64421 (multiple levels) because they were performed at separate settings.

Julie, CPC


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## mbort (Feb 16, 2009)

since this is a return to the OR on the same date of service, you are an ACS, he injected a totally different level, then I would use the 59 modifier.  

I would not use the 58 because it was not staged or planned at the time of the original injection to return the patient to OR (in other words not scheduled).

Since its a different level, 78 would not be appropriate either.

Mary, CPC, COSC


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## dmaec (Feb 16, 2009)

I agree with mbort - I'd be using a .59 modifier on the second code.
(nicely explained!)


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## jdrueppel (Feb 16, 2009)

I agree the -59 modifier is also appropriate, however, I've had carriers still deny the second block, same CPT code (different level) with the -59 modifier stating that since the CPT does not specify exact level that the -76 modifier is necessary to pass the edits.

Julie, CPC


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## sleepycats (Feb 16, 2009)

Thanks for your help.


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