CCO Admin asked:
Can you use 58 modifier in office setting? https://www.physicianspractice.com/blog/how-apply-modifier-58
Answer:
**Modifier 58** Staged or related procedure or service by the same physician during the postoperative period may be necessary to indicate the performance of a procedure during the postoperative period was: Planned prospectively at the time of the original procedure; or "staged;"
**Modifiers 58**; 78; and 79 **are not valid to use with or attach to evaluation and management (E/M) procedure codes.** Modifiers 58; 78; and 79 are considered valid for procedures with a Global Days indicator setting of 010 or 090. **Modifiers 58**; 78; and 79 are not considered valid for procedures with a Global Days indicator setting of 000; XXX; or ZZZ.
000 Zero day Medicare global period
010 10-day Medicare global period
090 90-day Medicare global period
YYY Global period is set by the carrier
ZZZ Add-on codes that are always billed with another service
**Modifiers 58**; 78; and 79 are mutually exclusive to one another; only one of these modifiers may apply to a service or procedure performed within a postoperative global period.
Services may not be "unrelated" to the procedure code creating the postoperative global period and also "related" to another procedure code performed by the same physician during that same original surgical session.
**Modifiers 58**; 78; and 79 do not bypass the usual multiple procedure fee reductions; bilateral fee adjustments; assistant surgeon fee adjustments; or any other applicable adjustments which may apply to a particular line item or situation.
Determining Whether Services Are Related; Staged; or Unrelated
When determining whether a subsequent procedure is related; staged; or unrelated to the original surgery; both the reason for the original surgery and the reason for the subsequent procedure must be considered.
? Services treating complications from the original surgery are always related.
? Procedures to treat or assist with expected developments in the healing process are always related.
? Services associated with returning the patient to the appropriate post-procedure state are always related; and unless they require a return to the operating/procedure room; reimbursement is included in the global surgery fee for the original surgical procedure(s).
? When the subsequent procedure would not have been needed if the original surgery had never been performed:
o Services on the operative site or contiguous structures are related to the original surgery.
o Services on a different body organ or unrelated operative site may be unrelated to the original surgery.
? Procedures to treat the same or similar problems in the contralateral; non-operative organ; extremity; or joint are unrelated.
Documentation for Review
Staged or anticipated procedures are a very specific type of related procedures. Documentation that the subsequent procedure was a staged or anticipated procedure of the original surgery may be included in the operative report for the original surgery or the preoperative documentation. Regardless of where the surgeon chooses to include this information; the office should either attach this documentation to the claim billed with modifier 58 or be prepared to submit this supporting documentation for review upon request in order to support the billing of the subsequent procedure as a staged procedure and qualify for the reimbursement rate for staged procedures
Coding Guidelines
When **modifier 58** is used; the staged relationship to the original surgery must be documented in the medical record. This does not necessarily mean that the final decision to perform the subsequent surgery or the date it will be performed is known at the time of the original surgery. "Decisions to perform subsequent procedure(s) may depend on the outcome of the surgery and the patients postoperative status. The term anticipated was added [to the description for modifier 58] because physicians can anticipate the potential for subsequent procedure(s) but cannot always predict it." (CPT Assistant 1 )
Medical coders; when appending this Modifier 58; need to be aware that the provider performed a procedure or service during the postoperative period and that it was:
? planned or anticipated (staged)
? more extensive than the original procedure? for therapy following a surgical procedure
Medical coders and physicians who are making notes and involved in the documentation; should be aware not to append modifier 58 to CPT codes that include multiple sessions or any services that could be part of the initial service. Further; Medicare adds an additional requirement - a return to the operating room (OR) is a must if applying modifier 58. A new "global period" begins for the second surgery; and most payers will thus reimburse the second surgery based on 100 percent of the fee scheduled. Thus; Modifier 58 may only be used during the "global surgical period"for the original procedure.
Can you use 58 modifier in office setting? https://www.physicianspractice.com/blog/how-apply-modifier-58
Answer:
**Modifier 58** Staged or related procedure or service by the same physician during the postoperative period may be necessary to indicate the performance of a procedure during the postoperative period was: Planned prospectively at the time of the original procedure; or "staged;"
**Modifiers 58**; 78; and 79 **are not valid to use with or attach to evaluation and management (E/M) procedure codes.** Modifiers 58; 78; and 79 are considered valid for procedures with a Global Days indicator setting of 010 or 090. **Modifiers 58**; 78; and 79 are not considered valid for procedures with a Global Days indicator setting of 000; XXX; or ZZZ.
000 Zero day Medicare global period
010 10-day Medicare global period
090 90-day Medicare global period
YYY Global period is set by the carrier
ZZZ Add-on codes that are always billed with another service
**Modifiers 58**; 78; and 79 are mutually exclusive to one another; only one of these modifiers may apply to a service or procedure performed within a postoperative global period.
Services may not be "unrelated" to the procedure code creating the postoperative global period and also "related" to another procedure code performed by the same physician during that same original surgical session.
**Modifiers 58**; 78; and 79 do not bypass the usual multiple procedure fee reductions; bilateral fee adjustments; assistant surgeon fee adjustments; or any other applicable adjustments which may apply to a particular line item or situation.
Determining Whether Services Are Related; Staged; or Unrelated
When determining whether a subsequent procedure is related; staged; or unrelated to the original surgery; both the reason for the original surgery and the reason for the subsequent procedure must be considered.
? Services treating complications from the original surgery are always related.
? Procedures to treat or assist with expected developments in the healing process are always related.
? Services associated with returning the patient to the appropriate post-procedure state are always related; and unless they require a return to the operating/procedure room; reimbursement is included in the global surgery fee for the original surgical procedure(s).
? When the subsequent procedure would not have been needed if the original surgery had never been performed:
o Services on the operative site or contiguous structures are related to the original surgery.
o Services on a different body organ or unrelated operative site may be unrelated to the original surgery.
? Procedures to treat the same or similar problems in the contralateral; non-operative organ; extremity; or joint are unrelated.
Documentation for Review
Staged or anticipated procedures are a very specific type of related procedures. Documentation that the subsequent procedure was a staged or anticipated procedure of the original surgery may be included in the operative report for the original surgery or the preoperative documentation. Regardless of where the surgeon chooses to include this information; the office should either attach this documentation to the claim billed with modifier 58 or be prepared to submit this supporting documentation for review upon request in order to support the billing of the subsequent procedure as a staged procedure and qualify for the reimbursement rate for staged procedures
Coding Guidelines
When **modifier 58** is used; the staged relationship to the original surgery must be documented in the medical record. This does not necessarily mean that the final decision to perform the subsequent surgery or the date it will be performed is known at the time of the original surgery. "Decisions to perform subsequent procedure(s) may depend on the outcome of the surgery and the patients postoperative status. The term anticipated was added [to the description for modifier 58] because physicians can anticipate the potential for subsequent procedure(s) but cannot always predict it." (CPT Assistant 1 )
Medical coders; when appending this Modifier 58; need to be aware that the provider performed a procedure or service during the postoperative period and that it was:
? planned or anticipated (staged)
? more extensive than the original procedure? for therapy following a surgical procedure
Medical coders and physicians who are making notes and involved in the documentation; should be aware not to append modifier 58 to CPT codes that include multiple sessions or any services that could be part of the initial service. Further; Medicare adds an additional requirement - a return to the operating room (OR) is a must if applying modifier 58. A new "global period" begins for the second surgery; and most payers will thus reimburse the second surgery based on 100 percent of the fee scheduled. Thus; Modifier 58 may only be used during the "global surgical period"for the original procedure.
Last edited: