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The
American Medical Association plans to issue clarifications
on when to use modifiers 58 (staged procedure) and 78 (return
to the operating room) soon (See PBI, Vol. 6, No. 24.).
But in the meantime, use these tips to correctly apply these
tricky modifiers.
Modifier
78 is usually for complications, such as bleeding, rupture
or infection, says Laureen Jandroep with the CRN Institute
in Absecon, NJ. The 58 modifier, by contrast, is for situations
where a surgeon does a procedure followed by a more extensive
procedure, such as a lumpectomy followed by a mastectomy.
One
important thing to remember is that modifier 58 resets the
global period for a surgery, and the 78 modifier doesn't,
notes Jandroep. "So you have to look at the situation.
Does it seem legitimate that the global should be reset?"
Also,
if the description for a particular code in the CPT book
says it's a staged procedure, that's a dead giveaway that
you should use the 58 modifier, says Jandroep. You shouldn't
use 58 with procedure codes that are described as one or
more services, or for unrelated procedures. And you shouldn't
use it with procedures that describe a subsequent stage,
such as Mohs surgery codes 17305 or 17307.
Generally,
if the physician knows up front that a procedure will have
subsequent stages, that means you'll use 58, notes Cathy
Brink, president of Healthcare Resource Management in Spring
Lake, NJ. Usually the physician should acknowledge up front
the possibility that he or she will have to return to the
OR -- and ideally that should be documented -- when you
use modifier 58.
You'll
usually use modifier 78, on the other hand, for a follow
up procedure that takes place relatively soon after the
initial procedure, notes Jandroep. "You're not going
to have a complication with an aneurysm repair two months
down the road." One reason the global period doesn't
reset with the 78 modifier is the fact that dealing with
a complication usually won't have a longer global period
than the original procedure.
You
should also be careful to avoid using 78 when the surgeon
repeats the original procedure. For that situation you should
use modifier 76 instead. You also shouldn't use the 78 modifier
if the follow-up procedure doesn't happen in the operating
room. Some physicians have faced investigation from the
Part B carriers for using the 78 modifier for treating post-operative
complications in the office setting, Jandroep reports.
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