General Surgery Coding Alert

Modifiers -58, -78 and -79:

Here's How to Choose the Right One

Published on Wed Oct 08, 2003

Let expert advice guide your decision 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. Use -58 for Related and/or Anticipated Procedures 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> (Staged or related procedure or service by the same physician during the postoperative period) when a procedure or service during the postoperative period is: a) planned prospectively at the time of the original procedure (staged) or b) more extensive than the original procedure or c) for therapy following a diagnostic surgical procedure. In each case the subsequent procedure or service is either related to the underlying problem/diagnosis that prompted the initial surgery or anticipated at the time the surgeon performs the initial surgery (or both) says Sharon Tucker CPC president of Seminars Plus a consulting firm specializing in coding documentation and compliance issues in Fountain Valley Calif. In other words the patient's condition 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. 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. Typically you append modifier -58 to identify a staged procedure - a procedure that requires more than one operative session to complete. For example a surgeon performs an excisional biopsy of the breast (19120 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) 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. Don't Be Confused by 'More Extensive' 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 [...]

You’ve reached your limit of free articles. Already a subscriber? Log in.

Not a subscriber? Subscribe today to continue reading this article. Plus, you’ll get:

Simple explanations of current healthcare regulations and payer programs
Real-world reporting scenarios solved by our expert coders
Industry news, such as MAC and RAC activities, the OIG Work Plan, and CERT reports
Instant access to every article ever published in your eNewsletter
6 annual AAPC-approved CEUs*
The latest updates for CPT®, ICD-10-CM, HCPCS Level II, NCCI edits, modifiers, compliance, technology, practice management, and more

*CEUs available with select eNewsletters.