# 58 or 78



## aguelfi (Nov 21, 2008)

I have a request for a refund on my desk for a patient who had a axillary node bx (38525 & 38792) abou 14 days after an excision an excision of breast lesion (19125).  I used a 78 modifier because the op-note doesn't specify that the bx was a planned return to the OR, however I do see how it could be necessary to use a 58.  We can't determine if the patient was going to return to OR until the results from the lesion removal are back. I'm interested to see what others think if they would use a 58, 78 or even something else.  Should I appeal this?


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## mbort (Nov 21, 2008)

I would have used 58 because it was directly related to the outcome of the 
pathology from the 1st surgery.


my two cents 
Mary


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## FTessaBartels (Nov 21, 2008)

*I'd use 58*

I would have used 58 modifier ... while you didn't exactly plan the return to the OR, the surgeon knew that if the path report said X he would take the patient back for this second procedure. 

I would definitely appeal.

F Tessa Bartels, CPC, CPC-E/M


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## okiesawyers (Nov 22, 2008)

**58**

I would have used the 58 modifier, however I would appeal!


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## aguelfi (Nov 26, 2008)

If I refund it, shouldn't I just be able to rebill w/ the correct modifier?


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## mbort (Nov 26, 2008)

yes you can do that, or appeal w/corrected claim


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## dpeterson39 (Nov 26, 2008)

abenson said:


> If I refund it, shouldn't I just be able to rebill w/ the correct modifier?


 
I'd think twice before refunding the money as the first step. As for which modifier, I would call this a 58 situation. Instead of refunding, and as long as there is no contractual obligation stopping you; I would send a corrected claim with the Modifier 58 and request that they update their system to reflect the modifier change. The 58 modifier as depicted in the CPT Appendix A states that it is a staged or related procedure/service. Then it gives options a, b, and c to define where the procedure or service fits. I would call your scenario option b- "_service is more extensive than the original procedure_". Another great resource that explains the intent of CPT and HCPCS Level II Modifiers is _Coding with Modifiers_ published by the AMA. The best rule of thumb with the 78 modifier is that a patient presents to the OR/Procedure Room unplanned with a complication steaming from the initial operative session. ​
Hope this is beneficial for you. ​


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## aguelfi (Dec 1, 2008)

This is great thanks.  I was trying to avoid the entire refund and rebill process.


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