Modifier 58
When is modifier 58 used?
Modifier 58 is a reimbursement modifier utilized in medical coding to indicate a staged or related procedure during the global period of a previously completed surgery. It is applied when a planned surgery requires additional procedures for definitive treatment or is planned in stages due to the patient’s condition. Modifier 58 allows for separate payment and recognition of the distinct services provided during subsequent procedures that are not a result of complications from the initial surgery or postoperative care.
This modifier is necessary to communicate that the postoperative service was either planned prospectively at the time of the original procedure, more extensive than the original procedure, or conducted for therapeutic purposes following a diagnostic surgical procedure. By adding modifier 58 to the staged or related procedure, healthcare providers can accurately convey the additional complexities or contingencies involved in the subsequent service.
This modifier is essential for ensuring accurate billing and reimbursement for such additional services that are planned or expected following an initial procedure. It signifies that the subsequent procedure is related to the original one and is part of the overall treatment plan for the patient.
Examples of modifier 58
Below are examples with scenarios demonstrating the application of Modifier 58:
A) Staged Procedure:
Scenario: A patient undergoes a laparoscopic cholecystectomy. During the initial procedure, the surgeon identifies multiple gallstones but decides to only remove a portion of them due to time constraints and patient condition. The surgeon plans to perform a second procedure in a follow-up session to remove the remaining gallstones.
Coding: The second procedure, which was planned prospectively at the time of the original procedure, would be appended with Modifier 58 to denote that it is a staged procedure.
B) More Extensive Procedure:
Scenario: A patient undergoes a skin biopsy for a suspicious lesion. The biopsy results come back positive for malignant melanoma, requiring a wide local excision to ensure complete removal of the cancerous tissue.
Coding: The wide local excision that is more extensive than the original procedure would be appended with Modifier 58, indicating that it is a related procedure performed during the postoperative period.
C) Therapy Following Diagnostic Procedure:
Scenario: A patient undergoes a diagnostic arthroscopy of the knee to investigate persistent joint pain. The arthroscopic procedure reveals a torn meniscus that requires surgical repair as a therapeutic intervention.
Coding: The surgical repair of the torn meniscus following the diagnostic arthroscopy would be appended with Modifier 58, signifying that it is for therapy following a diagnostic surgical procedure.
In summary, Modifier 58 is used to communicate specific circumstances where a staged or related procedure is performed by the same healthcare professional during the postoperative period.
Frequently asked questions:
Difference between modifier 58 and modifier 78?
Modifier 58 is used to indicate a staged or related procedure performed during the postoperative period of a previous surgery. It is appended to a service that is planned or anticipated following the original procedure, and it indicates that the subsequent procedure was more extensive than the original one. Modifier 58 resets the global surgical period for the subsequent procedure, allowing providers to receive separate payment for the additional service.
On the other hand, modifier 78 is used to indicate an unplanned return to the operating room for a related procedure during the postoperative period of the initial surgery. It is added to a service that is related to the original surgery and performed because of complications, to correct an issue, or due to the need for additional treatment.
While both modifiers involve additional procedures during the global period of a surgery, the key distinction lies in whether the subsequent procedure is planned (modifier 58) or unplanned (modifier 78) relative to the original surgery.
Can assistant surgeon bill modifier 58?
No, an assistant surgeon cannot bill using modifier 58. An assistant surgeon’s role is more oriented towards providing support during the primary surgery, rather than performing a separate, staged procedure. Therefore, using modifier 58 would not be appropriate for an assistant surgeon’s billing. Assistant surgeons, who are typically a different physician than the primary surgeon, should not use modifier 58 to bill for their services. Instead, assistant surgeons typically bill using modifier 80, 81, or 82, depending on the circumstances of the surgery.
Can modifier 58 and modifier 79 be used together?
Modifier 58 and modifier 79 cannot be used together on the same procedure code. Modifier 58 is used to indicate that a planned, staged, or related procedure was performed during the global/surgical period of a prior procedure, while modifier 79 is used to indicate an unrelated procedure or service performed by the same physician during the post-operative period. Therefore, using both modifiers on the same code would create conflicting information regarding the nature of the services provided.