Modifiers 58, 78 and 79 are used
only with the surgery codes in postoperative global period.
(Global period is the time
before, during, and after a surgical procedure that covers the patient care for
that particular surgical procedure. When a physician performs a new surgery procedure
for a patient who is within the global period of a previous surgery procedure,
the new surgery procedure must be distinguished by using a modifier)
The global period for the minor and
major surgeries,
1.
Minor surgeries - Either 0 days
or 10 days after the day of surgery
2.
Major surgeries - 90 days
Modifiers 58, 78, and 79 are mutually
exclusive to one another, only one of these modifiers would be used with the surgery
procedure performed within a postoperative global period.
The use of modifiers requires precise
perceptive of the purpose of each modifier.
Now we are going to see some of
the global period modifiers and how it would alters the reimbursement.
Modifier 58
The
modifier 58 - Staged or related procedure or service by the same physician during
the post-operative period.
It’s necessary to indicate that the
performance of a surgery procedure during the post-operative period was
a) Planned or staged,
b) Must be more extensive procedure than the
original procedure performed earlier,
c) For
therapy following a surgical procedure.
For the
above circumstances would be reported by adding modifier 58.
It’s
not obligatory that the physician has to mention planned stages in order for a
procedure to qualify for the modifier 58.
The
subsequent surgery procedure can be within a stated plan of care, and more
extensive procedure because the original procedure did not achieve the preferred
outcome as planned.
Note: Do not append modifier 58 to
procedures whose definitions include the description “one or more sessions” (Eg,
CPT 67105 - Repair of Retinal detachment, 1 or more sessions, Photocoagulation,
with or without drainage of sub retinal fluid) if the subsequent sessions are
performed during the postoperative period of the initial session.
Modifier 78
Modifier
78 – Unplanned return to the operating room by the same physician following the
initial procedure for a related procedure during the postoperative period
Modifier
78 is used to indicate the performance of a surgery procedure during the
postoperative period or on the same the treat the complication of original
procedure, which required return to the operating room following initial
surgery with 10 or 90 days global period.
When
the new surgery code used to describe a service for treatment of complications
is the same as the surgery code used in the original procedure still it’s must
to append modifier 78 with the subsequent procedure.
Basically
payment for surgical codes is divided into three parts, (pre-, intra- and post op)
which is 10, 70 and 20 percent of the allowable, respectively. When modifier
–78 is used, payment is made at 80 percent of the allowable.
Since
this payment doesn’t include the postoperative component’s 20 percent, a new
post op period doesn’t begin. Modifier 78 reimbursement is intra-operative
percentage only.
Note: Do not append modifier 78 to
assistant surgeon.
Modifier
78 is not used to report a repeat of the same surgery during the same operative
session.
Modifier 79
Modifier
79 - Unrelated procedure by the same physician following initial procedure during
the postoperative period.
Modifier
79 appended to surgical procedures performed on patients during the
postoperative period for a different/unrelated surgery. The new surgical
procedure is performed to treat a new problem during global period.
Note: Modifier 79 does not always
require a different diagnosis or a different surgery procedure. The same
procedure being performed on bilateral body parts in different operative sessions,
the subsequent surgery falls within the global period of previously performed
surgery then also we can append modifier 79.
Modifiers
78 and 79 should not be used to when multiple surgeries performed during the
same operative session.
How to determine whether a
subsequent procedure is related, staged, or unrelated to the original surgery,
The
reason for the original surgery and the reason for the subsequent procedure during
the global postoperative period must be considered.
1.
Services treating complications from the original surgery are always
related.
2.
Procedures to treat or assist with expected developments in the healing
process are always related.
3.
Procedures to treat the same or similar problems in the contra-lateral,
non-operative organ, extremity, or joint are unrelated.
Don’t append
modifier 78 when the procedure is performed at the place of service 11 (Office)