Wiki modifier 58

[akj]

I have a patient that had an I and D of an abscess in the abdominal area coded with 10060. Three days later, patient returned to the office because the wound was open, measuring 6cm in length. The physician closed the wound with 5 staples. This was coded with 99024, but the physician is questioning it, thinking something more should be billed. I thought of billing 12002 with modifier 58. I am getting conflicting information whether is is appropriate or not. One source is telling me because the 12002 has fewer RVU's than 10060, this isn't appropriate. Another resource says if he is finishing what he started, this would be ok to bill.

Please help!

 

[ehanna]

I have a patient that had an I and D of an abscess in the abdominal area coded with 10060. Three days later, patient returned to the office because the wound was open, measuring 6cm in length. The physician closed the wound with 5 staples. This was coded with 99024, but the physician is questioning it, thinking something more should be billed. I thought of billing 12002 with modifier 58. I am getting conflicting information whether is is appropriate or not. One source is telling me because the 12002 has fewer RVU's than 10060, this isn't appropriate. Another resource says if he is finishing what he started, this would be ok to bill.

Please help!

I believe 10060 has a 10 day global period (I am sure someone will correct me if I am wrong). If the patient presents within that 10 period anything that has to do with that particular procedure should be inclusive. I believe 99024 was the right call. I will be interested to see what others have to say.

 

[CodingKing]

58 means staged or related procedure. Was the would left open with a plan to close it on another date? Did he leave it open expecting it to heal and then it got worse? I'm thinking 12020 Treatment of superficial wound dehiscence but I'm not 100% sure about the modifier. Seems like complication which is not usually part of global.

 

[avon4117]

whatever procedure you decided to use append it with a 78 modifier if this is a unplanned related procedure

 

[CodingKing]

whatever procedure you decided to use append it with a 78 modifier if this is a unplanned related procedure

78 requires return to OR so office wouldn't count

http://www.wpsmedicare.com/j8macpartb/resources/modifiers/modifier-78.shtml

*An OR for this purpose is defined as a place of service specifically equipped and staffed for the sole purpose of performing procedures. The term includes a cardiac catheterization suite, a laser suite, or an endoscopy suite. It does not include a patient's room, a minor treatment room, a recovery room, or an intensive care unit.

 

[avon4117]

78 requires return to OR so office wouldn't count

http://www.wpsmedicare.com/j8macpartb/resources/modifiers/modifier-78.shtml

Thats interesting because we perform procedures in our office. If you have a procedure room then you should be able to use the 78 modifier, if not then I guess it will be considered part of the global package.

 

[akj]

Pos 11 is not allowed with mod 78.
Thanks to all for the replies... Every one of them is truly appreciated!