How accurate you can use Modifier 58 in Medical Billing?

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How accurate you can use Modifier 58 in Medical
Billing?
The modifier 58 is defined by CPT as staged or
related procedure or service by the
same physician during the post-operative period.
It may be necessary to indicate that the
performance of a procedure or service during the
postoperative period was a) planned or
anticipated (staged) b) more extensive than the
original procedure, or c) for therapy following a
surgical procedure. This circumstance may be
reported by adding modifier 58 to the staged or
related procedure. 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. A septoplasty (30520, 90-day global)
and functional endoscopic sinus surgery (FESS,
0-day or 10-day global) are performed during the
same surgical session. An endoscopic sinus
debridement (31237, S2342) is performed in the
office 14 days later. Because the debridement is
related to the FESS, then it is also related to
the septoplasty, and the 90-day global period
applies to the post-operative sinus
debridement. Some people think that the
physician has to specifically state planned
stages in order for a procedure to qualify for
the 58 modifier. This is not the case. The
subsequent procedure can be within a stated plan
of care, or it can be implied, executing a more
extensive procedure because the original
procedure did not achieve the desired outcome as
planned.
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How accurate you can use Modifier 58 in Medical
Billing?
The problem comes from ambiguity in the
definition of modifier 58 and 78. Modifiers 79
and (to a lesser extent) 59 compound the problem.
Theres even justified confusion involving
modifier 24. Using the wrong modifier can mean
denied claims. Worse, most of the information
currently available on the internet doesnt
exactly clarify the problem. Reviewing examples
can be particularly helpful with ambiguous
modifiers like this one. Here are some situations
when modifier 58 would apply. If a diagnostic
endoscopic procedure results in the decision to
perform an open procedure, both procedures may be
reported with modifier 58 appended to the
HCPCS/CPT code for the open procedure.  However,
if the endoscopic procedure preceding an open
procedure is a scout procedure to assess
anatomic landmarks and/or extent of disease, it
is not separately reportable. Example 1 A
patient undergoes an excision to remove a
malignant lesion from his skin. This procedure
includes a 10-day global period, and the surgeon
plans to perform the closure on the 9th day. In
this case, append modifier 58 to the closure code
since it was a subsequent procedure related to
the original procedure, and performed within the
global period.
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How accurate you can use Modifier 58 in Medical
Billing?

• Example 2
• A physician performs a debridement of a patients
  burn. The physician knows they will need to
  perform multiple debridements and makes sure to
  note this in the patients medical record. Every
  time the physician performs the additional
  debridements, he uses modifier 58.
• Example 3
• Another example of when to use modifier 58 would
  be if a patient had a removal of a breast lesion
  (CPT 19120) followed in less than 90 days by the
  removal of the entire breast (CPT 19307). Bill
  CPT 19307-58 for the second procedure. Another
  postoperative period begins when the second
  procedure in the series is billed.
• Inappropriate Usage of modifier 58
• Appending the modifier to ASC facility fee claims
• Appending the modifier to a procedure with XXX
  global period on the MPFSDB
• Appending the modifier to services listed in CPT
  as multiple sessions, (i.e. 67208, Destruction of
  localized lesion of a retina, one or more
  sessions)
• Reporting the treatment of a complication from
  the original surgery
• Unrelated procedures during the postoperative
  period