Wiki Which modifier 58 or 76

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southernbutterfli

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A co-worker and I have a difference of opinion on which modifier to use and I would like some help on clarification, please? A patient underwent a LEFT carotid endarterectomy in July. Same patient underwent a RIGHT carotid endarterectomy in October (within the global period). When my co-worker billed out the left, she didn't include a modifier indicating which side. I am in the process of billing out the right side and put a 58 modifier on it, since it was a scheduled outpatient procedure and on the other side. She insists we use a 76, stating that it is a repeat procedure. My arguement is that it isn't a repeat since it is on the right side and not the left side. Please help!!!???

I really would like to be correct on this, since she feels that her experience (without a degree or certification) far outweighs anything I could have learned while earning my degree and certification. Petty, I know, but you would have to work with her to understand :)
 
it would not be a 76 since it is not the same procedure repeated, you also would not use the 58 since it is not staged nor related, I would use the LT on the first and the RT on the second but other than that perhaps a 79 as they are unrelated when performed on opposite sides.
 
Well, you've thrown me now lol

Now I'm curious...

Since it was a scheduled procedure, wouldn't that be considered staged? And since both procedures were done because of her carotid stenosis and her blockage, wouldn't that also make them related?
 
I agree with Debra. You would only use the -76 modifier to report the service when the same procedure is performed by the same physician, on the same patient either the same day of the previous procedure or durng the global period. Since the procedure is being done on the RT side it is not a repeat but a new procedure, even if the body part is the same.
 
southernbutterfli said:
Well, you've thrown me now lol

Now I'm curious...

Since it was a scheduled procedure, wouldn't that be considered staged? And since both procedures were done because of her carotid stenosis and her blockage, wouldn't that also make them related?
Click to expand...

A staged procedure would be when you start with a more minor procedure like a lumpectomy and then based on say a path report the decision is made to return and perform a more extensive procedure of the same area, like a mastectomy.
It is not related because it is a different area of the body.
 
Thanks for clearing this up for me...however, she went ahead and filed the claim with the 76, and still didn't include which side of the body it was performed on.

But at least I'll know for future reference.
 
Did they KNOW when they did the July procedure they were going to do the other side in October? If that is the case, then it was a mod. 58 surgery in Oct. It does not have to be more extensive to qualify for a 58.
Staged: planned or anticipated
However, if this was not planned when they performed the first surgery but was rather discovered after the 1st surgery, then a mod. 78 would be appropriate.
In no instance would it be a mod. 76. Usually this is reserved for procedures that occurred on the same day but regardless, mod. 78 more accurately describes your circumstances (IF it was not planned).
Hope this helps.
 
It is not a 58 when it is a procedure for the other side, 58 is a planned procedure that is staged or related, a procedure for the other side neither staged nor related. 78 is an unplanned return for a related procedure and again a procedure on the opposite side is not considered related , the only possibility here is the 79, or an RT on the first procedure and an LT on the second.
I am sorry the coworker chose poorly!
 
Because this is on the opposite side of the body it is definitely not a -78 nor a -58. This would be in my opinion a -79 or an -RT. Which carotid was it? There are more than one. This sounds to me to be a procedure done on the common and the internal carotid, two different branches. Two different procedures.
This procedure was NOT due to a complication of the first procedure and even though it was planned it was not staged because it is on the opposite side of the body.
It would be the same if you had to amputate the left great toe for gangrene and decubitus ulcer and then a month later had to amputate the left little toe for the same reason. The left toe may have had an ulcer at the time of the first procedure but it really isn't related to or the result of the first procedure. The big toe and the little toe are two different entities.

So I agree with Debra, -79 or -RT.
 
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