Right Reimbursements for Postop Surgery with These Modifier Tips
Right Reimbursements for Postop Surgery with These Modifier Tips
You may be appending modifiers to your claims on a regular basis, but that doesn't mean you are filing correctly and getting the most appropriate pay. Here are some modifier tips for three of the most confusing modifiers: 58, 78, and 79.
Choosing between these modifiers can be carrier-specific in some situations.
Remember all possible uses for modifier 58
The descriptor for modifier 58 'Staged or related procedure by the same physician during the postoperative period' seems self-explanatory. Coders sometimes falter, however when they forget that modifier 58 actually applies to subsequent procedures that fall into one of these three categories:
Planned or anticipated (staged): A good instance might be an infected hand that has to be debrided many times over the course of a couple of weeks. You will not use a modifier on the first procedure, but will add modifier 58 on the subsequent procedures.
More extensive than the original procedure: The physician manipulates a patient's ulnar fracturel. An x-ray at the follow-up appointment shows that the reduction met with failure; as such the physician completes pinning or an open reduction with internal fixation (ORIF). Code the procedure as required and append modifier 58.
Therapy or treatment post a surgical or diagnostic procedure: This could apply to a soft tissue biopsy followed at a later date by malignant tumor excision. You will only append modifier 58 to the second procedure if it takes place during the first procedure's global period. The date of the second procedure resets the global period. You should expect 100 percent reimbursement for procedures you file with this particular modifier. Verify 'surprise' prior to reporting 78 If your physician completes a second but unplanned procedure related to the first, you might need modifier 78. Prior to appending modifier 78, confirm that the follow-up procedure was related to the original procedure but unplanned and that it occurred during the global period. Check all diagnoses to justify modifier 79 Sometimes a patient returns to the operating room for a procedure that is not related to the first surgery, however still within the first procedure's global period. In that case, you will consider appending modifier 79. Keep your modifier options straight with medical coding updates from a medical coding guide like Supercoder!