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solocoder

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Could I get some opinions, please, on whether this would be an appropriate use of modifier 58?

For patients whose healing potential is compromised by diabetic neuropathy or PVD, the doctor will often debride devitalised tissue from their foot surgery incisions to promote healing. (The surgeries include I&D, amputations and debridements)
WPS lists these scenarios for appropriate 58 usage:

1.To report a staged procedure planned at the time of the original procedure
2.When the staged procedure is more extensive than the original procedure
3.For therapy following a diagnostic surgical procedure
4.When performing a second or related procedure during the postoperative period.

Wouldn't scenario #4 apply to these debridements?
As yet I have not been able to get the doctors to document the need for possible "staged" debridements at the time of the surgery. But still trying! :)
 
This is just my opinion, but here goes. There has to be medical necessity for any encounter, just because a patient has a condition that may potentially compromise the healing process does not mean it will. The patient may not have any complications or could have many so the doctors could not document the need for a staged procedure because the patient may not require one. if the patient does require a debridement then the reason should be documented at the time which would still allow you to use 58 or even 78 depending on the circumstance.

NGS has LCDs for debridement services, I checked to see if your MAC has one. WPS has an LCD (L28572) "Wound Care" that should be helpful to you
 
Wound care is generally considered part of the post-operative care if performed by the same provider. In our wound care center, we would not bill a debridement with the 58 modifier because it generally does not meet the criteria you listed under points 1-3 above. (CMS guidance does not include your 4th point, per chapter 12 of the Medicare Claims Processing Manual.)
 
That is actually from our medicare carrier WPS website.

http://wpsmedicare.com/j5macpartb/resources/modifiers/modifier-58.shtml


Modifier 58 Fact Sheet
Definition
Indicates a staged or related procedure or service by the same physician* during the postoperative period
Appropriate Usage
To report a staged procedure planned at the time of the original procedure
When the staged procedure is more extensive than the original procedure
For therapy following a diagnostic surgical procedure
When performing a second or related procedure during the postoperative period.
 
I'm not sure why WPS would add that, but in looking at the page in your link, they do also say further down that 'treatment of a complication from the original surgery...that does not require a return trip to the operating room' is 'not separately payable'.

I'd recommend reading through section 40.1 of the Medicare Claim Processing Manual Chapter 12, which spells out the global surgery definition in more detail. In my experience, Medicare has held to the guideline that the global period includes 'All additional medical or surgical services required of the surgeon during the postoperative period of the surgery because of complications which do not require additional trips to the operating room', which would include debridements of the surgical wound not done in the OR. But ultimately it will be up to you to evaluate your documentation and determine whether or not the modifier is justified and can defended it if needed.

Incidentally, this may all be a moot point soon, as Medicare has proposed eliminating global periods completely within the next 2-3 years.

Hope this helps some!
Thomas Field, CPC, CEMC
 
In the CMS claims processing manual under Services and Supplies Not Included in the Global Surgery Policy it says:

Treatment for the underlying condition or an added course of treatment which isn't part of the normal surgical recovery.

Doesn't that sound like it would apply? since post op debridements are not part of "normal surgical recovery" for most people?
 
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