Reporting modifiers for services performed in the postoperative period
Modifier -58 describes a staged or related procedure or service by the same provider during the postoperative period. For outpatient hospitals, the postoperative period is defined as the same service date.
Report modifier -58 to indicate the performance of a procedure or service during the same calendar day postoperative period. For example, a scheduled diagnostic procedure might be performed in the morning, resulting in the decision by the surgeon to perform an unscheduled therapeutic procedure on the same patient later on the same day.
Because hospital outpatient reporting represents services performed within a given 24-hour period or a range of dates, the original intent and use of modifier -58 is not altered for hospital outpatient reporting.
Modifier -58 indicates that the reported procedure is related to the original procedure, intended to be performed sometime in the future as a "staged" procedure, and may represent the following:
- A procedure performed by the original surgeon or provider
- A follow-up surgery more extensive than the original procedure
- A therapy following a diagnostic surgical procedure
The use of the modifier -58 enables the fiscal intermediary or other payers/carriers to pay appropriately for the procedure per se and other associated postoperative services performed subsequent to the original procedure on the same calendar date (for outpatient hospital billing).
Modifier -58 is not used to report a related or unrelated procedure performed on the same date as the original procedure. To report this circumstance, use a different, more suitable modifier.
Also remember to check with your fiscal intermediary regarding local policy associated with the use of the modifier -58 for staged procedures on the same date.
Appropriate use of modifier -58
- To report a secondary procedure that was staged or planned at the time of the original procedure
- When the secondary procedure is more extensive than the original procedure
- For therapeutic services following a diagnostic procedure
- When performing a second or related procedure during the postoperative period
- Bill modifier -58 with the subsequent performed procedure
Inappropriate use of modifier -58
- Appending the modifier to services listed in CPT as multiple sessions (e.g., 67208, destruction of localized lesion of retina, one or more sessions)
- For a service that is treating a complication from the original surgery (see modifier -78)
- Unrelated procedures
For example, a spinal neurostimulator generator is inserted following the insertion of two neurostimulator leads and trial dosing performed earlier on the same calendar day.
Providers should report:
- 63650, percutaneous implantation of neurostimulator electrode
- 63650-59, percutaneous implantation of neurostimulator electrode?distinct procedural service
- 63685-58, insertion of spinal neurostimulator pulse generator?staged or related procedure by the same physician during the postoperative period
Reporting modifier -78
Modifier -78 describes a return to the operating room for a related procedure during the postoperative period. For outpatient hospitals, the postoperative period is defined as the same service date.
Use modifier -78 to indicate that another procedure was performed during the postoperative period of the initial procedure that was performed earlier in the same day.
For example, an unscheduled breast lumpectomy may be performed after a breast biopsy that took place earlier on the same calendar day or postoperative control of bleeding may occur for a procedure performed earlier on the same calendar day.
Use of modifiers applies to services/procedures performed on the same calendar day; thus, the postoperative period is defined as the calendar day on which the procedure/service was performed.
Ensure that modifier -78 is reported if the subsequent procedure does either of the following:
- Relates to the first procedure
- Requires the use of an operating room
Below are some of the CPT codes that are likely to be reported with modifier -78 when a patient returns to the operating room to have a postoperative complication treated:
- 10180, incision and drainage, complex, postoperative wound infection
- 42960, control of oropharyngeal hemorrhage, primary or secondary (e.g., post-tonsillectomy); simple
- 42961, control of oropharyngeal hemorrhage, primary or secondary (e.g., post-tonsillectomy); complicated, requiring hospitalization
- 42962, control of oropharyngeal hemorrhage, primary or secondary (e.g., post-tonsillectomy); with secondary surgical intervention
- 42970, control of nasopharyngeal hemorrhage, primary or secondary (e.g., postadenoidectomy); simple, with posterior nasal packs, with or without anterior packs and/or cautery
- 42971, control of nasopharyngeal hemorrhage, primary or secondary (e.g., postadenoidectomy); complicated, requiring hospitalization
- 42972, control of nasopharyngeal hemorrhage, primary or secondary (e.g., postadenoidectomy); with secondary surgical intervention
- 52601, transurethral electrosurgical resection of prostate, including control of postoperative bleeding, complete (vasectomy, meatotomy, cystourethroscopy, urethral calibration and/or dilation, and internal urethrotomy are included)
- 52647, non-contact laser coagulation of prostate, including control of postoperative bleeding, complete (vasectomy, meatotomy, cystourethroscopy, urethral calibration and/or dilation, and internal urethrotomy are included)
- 52648, contact laser vaporization with or without transurethral resection of prostate, including control of postoperative bleeding, complete (vasectomy, meatotomy, cystourethroscopy, urethral calibration and/or dilation, and internal urethrotomy are included)
Appropriate use of modifier -78
- To identify a related procedure requiring a return trip to the OR on the same day as another surgery
- Use modifier -78 on the second performed procedure (i.e., performed during the return trip)
- To treat the patient for complications resulting from the original surgery (it’s important to note the CPT definition for the modifier does not limit its use to treatment for complications)
- When the procedure code used to describe a service for treatment of complications is the same as the procedure code used in the original procedure, modifier -78 is still the correct modifier to use
Inappropriate use of modifier -78
- On any procedure code that does not fall on the same day as the original service
- When the surgery is unrelated to the original procedure
- On procedures performed in any place other than the OR
Note that an OR for this purpose is defined as a place of service specifically equipped and staffed for the sole purpose of performing procedures. The term includes a cardiac catheterization suite, a laser suite, or an endoscopy suite. It does not include a patient’s room, a minor treatment room, a recovery room, or an intensive care unit.
Reporting modifier -79
Modifier -79 is used to describe an unrelated procedure or service by the same physician during the postoperative period. For outpatient hospitals, the postoperative period is defined as the same service date.
Use modifier -79 to indicate that the performance of a procedure or service by the same physician during the postoperative period was unrelated to the original procedure that was performed earlier in the day.
You may need to use the modifier if the patient accounts/business office generates two bills for the same physician for the same date of service. This modifier would require a single bill and a single patient account number.
Editor’s note: This article is an excerpt from the HCPro book "JustCoding’s Guide to Modifiers: Hospital Outpatient Edition" by Susan E. Garrison, CHCA, CHCAS, CCS-P, CHC, PCS, FCS, CPAR, CPC, CPC-H. For more information, or to order a copy, see www.hcmarketplace.com.