Wiki Keloid Injection During a Global Period

[TianaElyse]

Patient is in a 90-day global period and is being seen a month later for subsequent keloid scar resulting from the procedure. Provider does an intralesional Kenalog injection to the scar.

Would the injection (11900/J3301) be included in the global surgery package and considered a complication, or is it billable with modifier -58 as a separate or related procedure during the global period?

 

[thomas7331]

An injection in most cases would not meet the definition of a staged procedure, which per CMS must be one of the following situations: planned prospectively or at the time of the original procedure; more extensive than the original procedure; or for therapy following a diagnostic surgical procedure. The situation you describe in my opinion would not support a modifier 58 and, since it's treatment of the scar complication, shouldn't be separately billed.

 

[TianaElyse]

An injection in most cases would not meet the definition of a staged procedure, which per CMS must be one of the following situations: planned prospectively or at the time of the original procedure; more extensive than the original procedure; or for therapy following a diagnostic surgical procedure. The situation you describe in my opinion would not support a modifier 58 and, since it's treatment of the scar complication, shouldn't be separately billed.

Thank you, Thomas! I may be reaching here, however I was not reading into modifier -58 to consider the injection as a staged procedure but rather a related procedure.

Modifier -58 description states "Indicates a staged or a related procedure or service by the same physician during the postoperative period." Medicare gives an example of "Appropriate Usage" being "When performing a second or related procedure during the postoperative period."

I'm not sure if a scar is considered a complication or if it can be its own diagnosis sequela to the initial procedure.

 

[thomas7331]

I would not code modifier 58 unless one of those three criteria I cited was met. Being a 'related' procedure, by itself, doesn't exempt a procedure from the global period. Think about it this way - if modifier 58 encompassed anything that was related, and modifier 79 anything that was unrelated, then every procedure that could possibly be done in the postoperative period would always be paid using one of those two modifiers.

A Kenalog injection is a very minor treatment directed at the healing of the wound. In my opinion, this is part of normal postoperative care and isn't significant enough to merit being classified as a 'staged' procedure and therefore doesn't warrant exemption from the global package. If you look for some articles that give clinical examples for the use of this modifiers, it's generally for procedures that can't be completed in a single session and for which the provider necessarily must plan a course of treatment that involves multiple operative sessions, not for minor treatments directed at recovery from the surgery. Just my thoughts.