Wiki modifier 78 vs 58

[davidskm]

Need opinions on using modifier 58 vs 78.
Initial surgery was 35355 & 35566. Pt comes back for large area debridement's almost weekly due to an infection. For all the debridement surgeries would you code them with a 58 or a 78 attached due to the initial surgery which has a 90global? The notes do not state anything about taking the patient back to OR for any of these services and were unplanned. One opinion is that 58 is "related/extensive" so it should be used but since this technically isn't on same location or initial problem (plaque in vessels) so modifier 78 should be used. Any thoughts?

 

[thomas7331]

It's hard to say without seeing the record. If the debridement was not done in the OR, then modifier 78 is definitely not appropriate. A 58 modifier also does not seem appropriate because that is for a 'staged' procedure, which is usually planned in advance as part of the course of treatment, or else is a second more extensive treatment directed at the same problem, which doesn't seem to be the case here.

If this debridement is being done due to a complication of the original procedure and is not done in the OR, then under the CMS rules, this is part of the global package and can't be reported. If, however, the documentation supports that this debridement is unrelated to original surgery, or the payer policy of the plan allows for billing for treatment of complications in the global period, then modifier 79 might be appropriate here.

I don't think the fact the debridement "isn't on the same location or initial problem" the way you described it would hold up or support using a modifier if the need for the debridement was related to the original procedure. If this infection is a complication of the procedure, then generally speaking debridement services outside the OR are part of the global payment and not billed separately.

 

[davidskm]

It's hard to say without seeing the record. If the debridement was not done in the OR, then modifier 78 is definitely not appropriate. A 58 modifier also does not seem appropriate because that is for a 'staged' procedure, which is usually planned in advance as part of the course of treatment, or else is a second more extensive treatment directed at the same problem, which doesn't seem to be the case here.

If this debridement is being done due to a complication of the original procedure and is not done in the OR, then under the CMS rules, this is part of the global package and can't be reported. If, however, the documentation supports that this debridement is unrelated to original surgery, or the payer policy of the plan allows for billing for treatment of complications in the global period, then modifier 79 might be appropriate here.

These were all taken back to the OR due to the size of the wounds.

 

[thomas7331]

These were all taken back to the OR due to the size of the wounds.

Your original post didn't say that, but if that's the case, then modifier 78 is correct. The operative note doesn't need to say the patient was taken to the OR - there will be facility records available should any payer question this and the payer will know from your place of service code and from the facility claim that this was the case.