Radiology Coding Alert

Question: If my radiologist inserts a urinary or biliary catheter and, because the patient has an infection, plans to delay the placement of a necessary stent until three days later, may I append modifier -58 to the second procedure?


New Mexico Subscriber

Answer: In general - check with your payer to see if it allows -58 (Staged or related procedure or service by the same physician during the postoperative procedure) with radiology services. Medicare typically leaves -58 off its list of acceptable radiology modifiers. If your payer does allow -58, your scenario is tailor-made for -58.

According to CPT guidelines, append -58 when you need to show that the second service was either staged (the physician decided at the time of the first procedure that he would have to perform an additional procedure during the global period), more extensive than the original procedure, or therapy after a diagnostic surgical procedure.

In the specific examples you give, the subsequent procedure (the stent placement) relates to the underlying problem that prompted the original surgery, meaning you may legitimately append -58 if your payer accepts it. But because stent placement is coded as an independent procedure whether performed directly after primary decompression of the urinary or biliary system or in a delayed manner, there is no reason to use modifier -58 unless the second procedure is performed during the global period of the former procedure (e.g., during the 90-day global period in the case of the biliary drainage).

Example: For the biliary catheter insertion, you report 47510 (Introduction of percutaneous transhepatic catheter for biliary drainage), which has a 90-day global period. For the second procedure, stent placement, you report 47511 (Introduction of percutaneous transhepatic stent for internal and external biliary drainage) and append -58 to avoid a denial. The operative report should explain the reason for the staged procedure.

Alternative: If your payer won't accept -58, you may be able to append -78 (Return to the operating room for a related procedure during the postoperative period) to the second procedure to indicate your right to reimbursement for this second procedure.

Never: You shouldn't append -58 when the patient needs a follow-up procedure because of surgical complications or unexpected but related postoperative findings. Modifier -78 is more appropriate in these scenarios.