General Surgery Coding Alert

<font helvetica="" sans-serif"="" face="arial"><strong><em><font size="3">Let expert advice guide your decision</font></em></strong><br><br>Can you easily distinguish between modifiers -58 -78 and -79? If not you'll need to brush up on some modifier basics. Knowing when to apply each can mean the difference between complete reimbursement and costly claim denials.<br><strong> <br>Use -58 for Related and/or Anticipated Procedures</strong> <br> <br>You should apply <a href="https://www.aapc.com/codes/cpt-codes-range/1045" _cke_saved_href="https://www.aapc.com/codes/cpt-codes-range/1045">modifier -58</a> (<em>Staged or related procedure or service by the same physician during the postoperative period</em>) when a procedure or service during the postoperative period is:<br> a) planned prospectively at the time of the original procedure (staged) or<br> b) more extensive than the original procedure or<br> c) for therapy following a diagnostic surgical procedure.</font></p> <p><font face="arial helvetica sans-serif">In each case the subsequent procedure or service is either <em>related</em> to the underlying problem/diagnosis that prompted the initial surgery or <em>anticipated</em> at the time the surgeon performs the initial surgery (or both) says <strong>Sharon Tucker CPC</strong> president of Seminars Plus a consulting firm specializing in coding documentation and compliance issues in Fountain Valley Calif. <br> <br>In other words the patient's<em> condition</em> rather than the results of a previous surgery dictates the need for additional procedures Tucker says. You should not use modifier -58 if the patient needs a follow-up procedure because of surgical complications or unexpected post-operative findings that arise from the initial surgery.<br> <br>The surgeon does not need to return the patient to the operating room (OR) to make use of modifier -58. The surgeon may provide a postoperative procedure or service for instance in his or her office or other outpatient setting. In all cases however the same physician must provide both the initial service/procedure and the follow-up procedure that requires modifier -58 Tucker says.<br> <br>Typically you append modifier -58 to identify a staged procedure - a procedure that requires more than one operative session to complete.<br> <br>For example a surgeon performs an excisional biopsy of the breast (19120 <em>Excision of cyst fibroadenoma or other benign or malignant tumor aberrant breast tissue duct lesion nipple or areolar lesion [except 19140] open male or female one or more lesions</em>) which includes a 90-day global period. The pathology report which returns a few days later indicates a malignant tumor. The surgeon decides to perform a modified radical mastectomy (19240). In this case you should append modifier -58 to 19240 to indicate a staged procedure which means that the payer should not bundle the mastectomy into 19120's 90-day global period.</font></p> <p><font face="arial helvetica sans-serif"><strong>Don't Be Confused by 'More Extensive'</strong></font></p> <p><font face="arial helvetica sans-serif">A "more extensive" procedure to which you append modifier -58 doesn't need to be more complex or time-intensive than the original procedure (although it can be). Rather the surgeon's subsequent procedure need only be more extensive than the work he or she performed during the initial procedure Tucker says. Here again however the patient's condition - not complications from the initial surgery - must drive the decision to perform an additional procedure(s).<br> <br>For example the surgeon amputates a diabetic patient's limb. Due to peripheral vascular problems the patient later requires a further amputation of the same limb. In this case you should append modifier -58 to the second amputation code to indicate that this second surgery is related to but more extensive than the initial amputation.</font></p> <p><font face="arial helvetica sans-serif"><strong>If It's a Complication Turn to -78</strong></font></p> <p><font face="arial helvetica sans-serif"> Unlike modifier -58 you should apply modifier -78 (<em>Return to the operating room for a related procedure during the postoperative period</em>) when conditions arising from the initial surgery - rather than the patient's condition - call for a related procedure Tucker says. In other words you should append modifier -78 to procedures required only due to complications arising from the original procedure.<br> <br><em>Note: If the medical record does not clearly indicate the reason for the subsequent surgery you should check with the operating physician prior to selecting a modifier.</em><br> <br> <a href="https://www.aapc.com/codes/cpt-codes-range/1045" _cke_saved_href="https://www.aapc.com/codes/cpt-codes-range/1045">Modifier -78</a> also requires that the surgeon return the patient to the OR. For Medicare payers any initial surgery complications that the surgeon handles in an outpatient setting such as infection bleeding or perforation are covered under the surgery's global period according to Medicare guidelines.<br> <br>For instance the surgeon performs a splenectomy (38100 <em>Splenectomy; total [separate procedure]).</em> During the global period the patient develops a significant wound dehiscence. The surgeon returns the patient to the OR to treat the dehiscence (13160 <em>Secondary closure of surgical wound or dehiscence extensive or complicated</em>). Report 13160 with modifier -78 to show a return to the OR to treat the complication of the previous surgery. You should link 13160 to a new primary diagnosis of wound dehiscence (998.3x <em>Disruption of operation wound; dehiscence of operation wound</em>).</font></p> <p><font face="arial helvetica sans-serif"><strong>Apply -79 for Unrelated Procedure Same Physician</strong></font></p> <p><font face="arial helvetica sans-serif">Not all surgeries during the global period are related to either the previous surgery or an underlying patient condition. In such cases you should append <a href="https://www.aapc.com/codes/cpt-codes-range/1045" _cke_saved_href="https://www.aapc.com/codes/cpt-codes-range/1045">modifier -79</a> (<em>Unrelated procedure or service by the same physician during the postoperative period</em>). In other words if the same surgeon must perform a separate evaluation and a distinct unrelated surgery - including all follow-up - for an unexpected medical condition during the global period of a previous procedure you should append modifier -79 to the subsequent procedural code(s).<br> <br>Generally the surgeon will perform a separate E/M service for the new problem before returning to the OR. You may report this E/M service by appending modifier -24 (<em>Unrelated E/M service by the same physician during a postoperative period</em>) to the appropriate E/M service code says <strong>Terry Fletcher BS CPC CCS-P</strong> an independent surgery coding specialist in Laguna Beach Calif.<br> <br>For example a surgeon performs a modified radical mastectomy and axillary node dissection (19240). The patient then sees an oncologist who recommends chemotherapy. Because the patient's peripheral veins cannot handle the delivery of the chemotherapy the oncologist asks the same surgeon who performed the mastectomy to implant a venous access device (36533). The device insertion is unrelated to the mastectomy so you may report it separately with modifier -79. If the surgeon performs a significant E/M service prior to the insertion you may also report the appropriate E/M service code with modifier -24.<br> <br><em>Note: Modifier usage can vary by payer. Although the above recommendations follow CPT guidelines check with your payer before applying modifiers -58 -78 or -79.</em> </font></p><p></p>