Optometry Coding & Billing Alert

Question: I'm not clear on the ways modifier -58 can be used, and I keep getting denials. Would you explain when and how to use this modifier?

North Carolina Subscriber

Answer: Modifier -58 often leaves billing offices in surgical practices pulling their hair out in frustration, but you can escape this fate by learning the basics.
  
This modifier indicates a "staged or related procedure or service by the same physician during the post-operative period" and is used most often by ophthalmologists, plastic surgeons and orthopedic surgeons, says Quin Buechner, MS, M.Div, CPC, CHCO, president of ProActive Consultants in Cumberland, Wis. And all in all, "it's a big pain in the rear," he says.
 
The problem is that many providers don't understand that there are technically three ways you can use -58, says Margie Vaught, CPC, CCS-T, an independent consultant in Ellensburg, Wash.:
 1. to indicate a planned, or staged, procedure
 2. to show a more extensive procedure following a less extensive one
 3. to indicate a diagnostic procedure followed by the therapeutic procedure.

The biggest mistake people make with modifier -58 is assuming they can't use it if the surgeon didn't plan to do the procedures, Vaught says. "Well, that's not the only thing the modifier is for," she reminds providers.