Ophthalmology and Optometry Coding Alert

Question: We performed a retinal detachment repair on a patient, and the following week, he returned because the retinal detachment recurred in the same location as the previous one. Should we append modifier 58 (Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period) to 67108 (Repair of retinal detachment; with vitrectomy, any method, including, when performed, air or gas tamponade, focal endolaser photocoagulation, cryotherapy, drainage of subretinal fluid, scleral buckling, and/or removal of lens by same technique)?

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Answer: Although your instinct might tell you that you can append modifier 58 to the retinal detachment repair code, the reality is that modifier 58 can’t be used simply because another procedure is being performed to fix the initial problem.

The correct modifier for a return to the OR within the global period is 78 (Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period).

Call on modifier 58 when the surgeon performs a secondary surgery during the post-op period of another surgery and the subsequent procedure was planned or staged. Modifier 58 requires that you meet one of three criteria:

1. The subsequent surgery is planned prospectively at the time of the original procedure (staged)
2. The subsequent surgery is more extensive than the original procedure
3. The subsequent surgery is therapeutic following a diagnostic surgical procedure.

The example above does not meet the first criterion because the physician did not plan for the retina to detach again, it does not meet the second criterion because the first and second procedures would be valued the same, and the third criterion also does not apply to the example. Therefore, you cannot append modifier 58 to code 67108 a second time under these circumstances