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Bella Cullen

Bella Cullen

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hello,
I was wondering if dr did fracture care on 11/11/09 with no plans for surgery, then comes back again for an xray on 12/16/09 and then decides patient needs surgery (ORIF) on 12/30/09. Is the initial fracture care still billable and the surgery is billed with a 58 modifier?
Not sure, any input is appreciated.
Thanks,
Melissa, CPC :confused:
 
Hi...I agree with Lisa...yes, the initial fracture treatment is billable...
however - I have to disagree with Lisa...no modifier .58 is needed... it would only be needed IF the surgery fell within the global (day before/day of) surgery - but the initial care was in November... the decision for surgery was days/weeks later....

:)
 
dmaec said:
Hi...I agree with Lisa...yes, the initial fracture treatment is billable...
however - I have to disagree with Lisa...no modifier .58 is needed... it would only be needed IF the surgery fell within the global (day before/day of) surgery - but the initial care was in November... the decision for surgery was days/weeks later....

:)
Click to expand...

Thanks for your input. I think you're thinking of mod 57 decision for surgery. I'm saying 58 on the surgery code for related to procedure in global.
Thanks again,
Melissa,CPC
 
!!!! thanks Melissa!! you are correct! that's what I was thinking...57...

aaaaaand.... lol..then yes...I agree with Lisa on all points! AND YOU! :)

thanks again!!
 
-57 vs. -58

I'm thinking that perhaps the -57 be appended to the E&M for the date of service that resulted in the decision for the surgery and the -58 be appended to the actual surgery when it takes place...

Anyone agree?
 
might as well as my two cents.

yes the initial care is billable from the November DOS

I dont think 58 is the appropriate modifier for the Dec DOS. This procedure is not "staged" (only related)

I think 78 is the more appropriate modifier on the 2nd surgery as the patient was treated for the fracture, now the fracture has migrated (a complication) and now the patient is being taken back for additional treatment.

my two cents :)
 
Modifier -58

I say -58 because the original fracture care was not enough, therefore a more extensive procedure is being performed...modifier -58. Modifier -58 does not only mean "staged", but also "more extensive than the original procedure".
 
at what point do you report that this was a complication (78)?

Improper use of the 58 can lead to audits. I would highly recommend research on the use of 58 versus 78 to prevent audit/refund/OIG issues.
 
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I guess what we really need to know is if there is a complication (change in the fracture setting) or if it just isn't healing and therefore needs an ORIF. That could be the difference -58 and -78. I didn't see anything in the post about a complication or that the alignment has changed.
 
Lisa Curtis said:
I guess what we really need to know is if there is a complication (change in the fracture setting) or if it just isn't healing and therefore needs an ORIF. That could be the difference -58 and -78. I didn't see anything in the post about a complication or that the alignment has changed.
Click to expand...

True, I guess I have just been in ortho too long and pretty much assume (which I know I should not) that if they were seen a month ago and treated with fracture care and they come back and have an x-ray and the decision is made for an ORIF, chances are that there is some sort of complication involving a non-union, mal-union or re-displacement of the fracture. :)
 
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