Podiatry Coding & Billing Alert

Question: I have a question about modifiers 79 (Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period) and 58 (Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period). We have a patient who came in for a follow-up visit presenting a new problem that required the doctor to perform CPT^® 11042 (Debridement, subcutaneous tissue [includes epidermis and dermis, if performed]; first 20 sq cm or less). Is it correct to bill CPT^® 11042 with both modifiers 79 and 58, since he’s within the post-op global period for a toe amputation?

Texas Subscriber

Answer: When you submit the claim, your notes need to be clear about what exactly “presenting a new problem” means in this case. It’s not readily obvious as to whether the ulcer was at a different sight than the amputation or not. Was the amputation site in need of local clean up? If it was the same site, did the wound open because of a following injury, resulting in a need for the debridement? 

As for the modifiers, you cannot apply both to a procedure. The 58 modifier implies a staged or related procedure while the 79 modifier is reserved for a completely unrelated procedure. 

A toe amputation has a 90-day global period, so debridement of the amputation site within the global period may be included in the amputation global fee allowance depending on the payer. This is especially true for Medicare if the procedure is not performed in an operating room.