General Surgery Coding Alert

Question: One month after a needle excision, the surgeon performs a re-excision of breast cancer with both superior and lateral margins. I know I-ll need a modifier when reporting the re-excision, but which is correct: modifier 58 or 78?


New York Subscriber

Answer: In this case, for both accurate coding and optimal reimbursement, modifier 58 (Staged or related procedure or service by the same physician during the postoperative period) is the better choice. You use modifier 78 (return to the operating room for a related procedure during the postoperative period) only for surgical complications, which is not the case here.

Modifier 58 applies when the surgeon performs a -more extensive procedure- during the postoperative period, according to CPT guidelines. In this case, the re-excision is clearly -more extensive- than the original excision. More important, however, CPT instructions preceding the Excision of Malignant Lesion codes (11600-11646) specifically state, -When frozen section pathology shows the margins of excision were not adequate, an additional excision may be necessary - Append modifier 58 if the re-excision procedure is performed during the postoperative period of the primary excision procedure.-

As mentioned, modifier 58 will also benefit your reimbursement. Whereas modifier 78 pays only for the procedure's intraoperative portion and does not reset the global period, modifier 58 allows for full payment and triggers the start of a new global period.

In this case, then, you will want to choose a correct code from the excision series 11600-11606 (Excision, malignant lesion including margins, trunk, arms or legs -) as determined by the size of the re-excision, and append modifier 58.