General Surgery Coding Alert

Question: The patient underwent colectomy to remove cancerous tissue. During the procedures- global period, the surgeon placed venous access for chemotherapy. Which modifier is correct for the venous access procedure, 58, 78 or 79?


Maine Subscriber

Answer: You are correct to assume that you need a modifier when reporting a different procedure during the global period of the colectomy (such as 44140, Colectomy, partial; with anastomosis).

In this case, you should report the appropriate venous access code (for instance, 36555, Insertion of non-tunneled centrally inserted central venous catheter; under 5 years of age) and append modifier 79 (Unrelated procedure or service by the same physician during the postoperative period) because the venous access (for chemotherapy) is unrelated to the earlier colectomy (to remove cancerous tissue).

One could argue, however, that modifier 58 (Staged or related procedure or service by the same physician during the postoperative period) -- rather than 79 -- is appropriate in this circumstance because the venous access is -related- to the colectomy in that both procedures are a result of the same diagnosis (the cancer). CPT instructions specifically allow you to use modifier 58 when two or more procedures are -related to the same underlying condition.-

Ultimately, you could make a convincing case for either modifier, but if you have doubts, contact your carrier for its suggestions. Be sure to get any instructions in writing for later reference.