My Modifier Moment-Modifier 58
Modifier 58 can be often confused with modifier 78.
Modifier 58 is a staged or related service done in the post operative period of another global procedure by the same physician. Modifier 58 also resets the global period unlike modifier 78.
The other error frequently made is adding this modifier on procedures with XXX global period which are typically your add-on codes and should not have global modifiers appended.
This modifier is not used for procedural complications or returns to the OR that are unrelated to the initial service.
Modifier 58 should be used to complete a staged service or to provide a more extensive service. The key is to know if this has been planned either at the time of service to complete a procedure or prospectively as a more extensive procedure becomes necessary.
Let’s look at some examples of staged or related services.
- Ex. 1-Patient broke ankle in an MVA and has multiple trauma so the surgeon takes to the OR to place an external fixative but plans to return later to the OR to remove the external fixation and complete an internal fixation of the fracture. If in the global of the first service use modifier 58.
- Ex 2- Patient is having an infection of an artificial joint that they have had many years. In the first operative session (stage 1) the joint may be removed and a spacer may be placed. In additional stages they may return to the OR to further wash out the joint. Lastly, when all infection is gone the patient may go back to have a new joint placed- all the stages following the first and if a full 90 days did not pass a 58 would be the correct modifier.
- Ex 3-As you know when a patient is placed in Fracture care global period whether they had surgery to fix the fracture ( open treatment) or just manipulation or stabilization ( closed treatment) , the first cast is inclusive in the fracture CPT. But most likely the cast will not last through the global period and will need to be changed. Because cast application is in CPT listing as a surgical service and is related to the initial surgery, 58 is the correct modifier.
- Ex 4- The doctor manipulates a fracture and sets the bone and on follow up sees the bones have displaced more than is acceptable and now feels the patient should go to the OR for a pin or internal fixation surgery- 58 would be appropriate as this service is more extensive than the first .
There are other good examples but I would suggest you ask yourself these questions …
1. – Is this is a service to complete the initial service?
2.-Is this service more extensive than the initial service?
If the answer is yes then 58 is the modifier you should append