Wiki modifier 79 vs 58

[wfriddle]

I am in need of some assistance. I have encountered a situation that has caused me some confusion and I am hoping someone can help clarify.
Here is the situation...

A patient has a TVT (57288) procedure done. During the global period of this procedure they may have to come in to the office to have a catheter put in for urine retention. A straight cath (51701) is being used and the patient are sometimes taught how to self cath at this same appt.

In this situation would this be considered a complication of the surgery and not billable? Am I able to add a mod 79 since a different diagnosis is used? Or should I consider this a staged or related procedure and add mod 58?

I do not want to just consider this global and not get paid for these services if we legitimately can bill for them but I of course also want to be compliant.

Any help or suggestion would be greatly appreciated.

 

[OCD_coder]

I am answering only because I just had a conversation with a urologist I was working with on this very scenario. He told me this is a complication frequently with some women post-surgery of a sling operation.

Since I don't know if the patient is Medicare or not, I am going to give you the Medicare rules first. This catheter placement is not billable separately as all care in the global period is bundled and included in the surgical package unless the patient goes to the OR.

Then apply the modifier 78 for commercial carriers. This way the provider get paid for the surgical care only as the pre and postop fee is subtracted out.

 

[wfriddle]

I completely understand what you are saying and it is part of the reason I have had confusion on this. If that is the case when would it be appropriate to use mod 58? This is for a staged or related procedure during the post-op period. If anything that is done in the post-op period, except a return to the OR, is inclusive?

I wonder if I can ask you a sort of related question since you have a urologist at your disposal. If my doctor performs a cystoscopy at the time of a hysterectomy b/c the pt had extensive adhesions and fibroids and she felt it necessary to check for injury. Now I have told her that a procedure done to check for injury is considered inclusive but she made a good point. If she was not trained to do this procedure she would have to have a urologist come in and perform the procedure. Would that urologist then not get paid for that procedure?