Modifiers -58, -78 and -79:
Here's How to Choose the Right One
Published on Wed Oct 08, 2003
<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 [...]