Podiatry Coding & Billing Alert

Hint: Don't confuse modifiers 58 and 78.

As a podiatry coder, you know how important modifiers are on your claims. Modifiers let you to tell your payers that although a specific circumstance may have altered the service or procedure your podiatrist performed, the definition or code of the service stayed the same.

Bust three common modifier myths to pave your way to cleaner claims.

Myth #1: You Can Report Bilateral Procedures With Both Modifiers 50 & RT/LT

Reality: You should never report bilateral procedures with both modifier 50 (Bilateral procedure) and RT (Right side) or LT (Left side). Also, your claim will be returned if you use RT and LT when modifier 50 applies.  

"Problems occur if claims indicate modifier 50 and also LT or RT - it's one or the other," explains Catherine A. Brink, BS, CMM, CPC, CMSCS, president of HealthCare Resource Management Inc. in Spring Lake, New Jersey.

Don't miss: For examples of appropriate ways to report bilateral services, look to the following information from Novitas' website:

• Report one line appending modifier 50 using one unit of service, or
• Bill modifiers RT & LT instead of modifier 50.

            o Report one line appending modifiers RT and LT using two units of service.
            o Report two lines using modifiers RT and LT with one unit of service on each line.

Appropriate Modifier 50 use: You use modifier 50 to indicate procedures performed on both sides of the body at the same operative session, said Arlene Dunphy, CPC, provider outreach and education consultant at National Government Services (NGS), in a recent webinar.

Check your LCDs: You should read your local coverage determinations (LCDs) and review your payers' policies and guidelines for specific information on reporting bilateral services, Dunphy added.

Example: During the same operative session, on the same date of service, the podiatrist applied an Unna boot to each of the patient's legs. In this scenario, you would report 29580 (Strapping; Unna boot) appended with modifier 50, rather than billing for two separate units of 29580. Payers will reimburse 150 percent of the usual allowable amount.

Notice: You would not append both modifier 50 and modifiers RT and LT on this claim. You would just append modifier 50.

Myth #2: You Should Append Modifier 58 if Procedure was Unplanned

Reality: Modifier 58 (Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period) applies to planned procedures, not unplanned procedures.

Modifier 58 indicates procedures during the global period that one plans (staged procedures), procedures that are more extensive than the original procedure, and for therapy following a surgical procedure.

For example: A diabetic patient presents with a 2cm ulcer on the plantar surface of the left foot under the second and third metatarsal head. Imaging shows second metatarsal osteomyelitis, and the podiatrist takes the patient to the OR for surgery for wound debridement with excision of the second metatarsal head. The wound is packed open and will be closed at a later date.

Two weeks later, the patient returns to the OR for debridement of the wound and closure with a full thickness skin graft (13160-58,  Secondary closure of surgical wound or dehiscence, extensive or complicated).

Because this was a planned return to the OR, you should append modifier 58 to this procedure.

Myth # 3: Include 78 on Claims for Planned, Unrelated Complications

Reality: You should include modifier 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) on claims for unplanned, related complications.

Use modifier 78 "when the patient returns to the OR (operating room) during the global period of another procedure for a complication or other unanticipated problem" related to the initial surgery, says Marcella Bucknam, CPC, CCS-P, COC, CCS, CPC-P, CPC-I, CCC, COBGC, revenue cycle analyst with Klickitat Valley Health in Goldendale, Washington.

Caution: Do not bill procedures related to the problem for which the patient is in a global period (even a debridement of this post-op infection site) if the procedure occurs in the office.

Location matters: You should only use modifier 78 when the patient returns to "an operating room, procedure room or an endoscopy suite during the postop period with a related complication," adds Cyndee Weston, CPC, CMC, CMRS, executive director of the American Medical Billing Association (AMBA) in Davis, Oklahoma.

Also: That return to the OR/procedure room would be with the same surgeon, or a surgeon within the same practice and specialty, if you're using 78. This modifier shows the payer that, although the patient is in his postoperative period, the physician had to perform an additional surgery.