On Jan19/18 performed bx and destruction of ulcerated mass on septum. Code 30117 was used. This was done in the office trying to avoid a trip to the ER for this 91 yr old female. Based on the pathology report it was necessary to go to the OR. On 2/12/18 a complex excision of left septal mass with reconstruction and placement of silicone sheeting, bilateral inferior turbinate outfracture for access was performed. Medicare complete denied 2/12/18 as part of global period. Would 58 be the best modifier to use on the 2/12 surgery? 78 would be appropriate except the 1st procedure was done in the office. Any recommendations?