# Modifier 58 versus 78



## cswaney (Dec 13, 2010)

Hope someone can help with some input on this one. Where I work we often do wound vac's on patients after major open heart/chest surgery. I would code the vac changes as 15852 -58, but now I am unsure about the modifier. They do not always go back to the operating room to have the procedure done, so should I be using the 58 modifier when they do not go to the operating room and 78 when they do go back to the operating room. I think I got confused because modifer 78 states "unplanned" and with wound vac's it is "planned" that they change them. Can anyone give me some useful insight on this topic?

Christine


----------



## btadlock1 (Dec 13, 2010)

In this case, "planned" = "staged". I'd use 58.


----------



## Dlee (Dec 13, 2010)

*Wound vac changes*

My doctor does a lot of wound vac changes for different types of injuries and post-surgeries.  I have been most successful using procedure codes 97598 and 97606 with modifier 58 for the planned changes.  Once in a while I will use 78  when there are complications that are not planned (obviously) and he has to go back and do a debridement and then use the wound vac.  There are different codes for debridement that I use as well, along with the wound vac codes.  
hope this helps!


----------



## annettehai (Dec 13, 2010)

*A. Hai, RN, RNFA, CPC, ACS-UR*

The key to using 58 vs 78 can be found in the original operative note.  Any procedure that is planned prospectively by the surgeon to be done in the post-operative period and stated as such in the original op note, should be coded with a 58.  Changing the wound vac is a great example of this. When it was applied initially, it was with the understanding that it will need to be changed during the global period.  Encourage the surgeon to note this in their dictations.  78 should be used for complications or "unplanned"/ unforseen procedure that needs to be done that is related to the original procedure. The language changed for the modifier last year and it does not have to be done in a formal OR, it can be in a dedicated _procedure room _in the office or ASC setting.


----------



## NaliniAAPC (Dec 13, 2010)

Hi, 
78 should be used for unplanned  procedure that needs to be done that is related to the original procedure, for eg:amputation procedures..for the post op period they need to correct the complication in stump ...and modifier 58 is staged procedure service by the same physician...
eg;dressing change...

Regards,
Nalini


----------



## cswaney (Dec 16, 2010)

Thanks for the helpful information, which leads me to another question that I don't think I asked the first time. Where the confusion comes in with these two modifiers is if say for example the patient comes back for a planned VAC change which is done in the OR. We have debated here about the use of modifiers with this senerio, because modifier 58 does not designate where the service is taking place where as 78 states its a return to the operating room. So we are unsure if it's a planned wound vac done in the operating room should we append both modifier 58 and 78 or only 58, since 58 does not state that the procedure is done in the operating room. Can you help?


----------



## btadlock1 (Dec 16, 2010)

You will need to know if it's planned or unplanned - that's a more important detail than whether or not it happened in an OR. It would be better to get clarification than to code something as unplanned when it was staged.


----------



## KMfromLV (Jan 26, 2011)

*What about Xrays?*

I am having a hard time with payment for Xrays during the global period.  The physician may do an osteoectomy of the 3rd metatarsal with an implant, then do an XRay in the office after 10 days to see if the hardware is okay.  

Correct modifier?  I have tried 58 (bundled as global for claims starting in Jan), and 78 (still including in the global)

Or am I beating a dead horse and they have decided to include everything in the global period for 2011?  I have even had a return to OR with mod 78 due to wound dehisience and implant rejection denied.....


----------

