Guidelines To Distinguish Modifiers -58, -78 and -79
Published on Thu Nov 01, 2001
Occasionally, a surgeon must return a patient to the operating room (OR) during the global period of a surgery. To designate that this subsequent procedure is independent and separately payable, the coder must attach a modifier to the appropriate CPT code. Depending on the circumstances that prompt the return to the OR, modifier -58 (staged or related procedure or service by the same physician during the postoperative period), -78 (return to the operating room for a related procedure during the postoperative period) or -79 (unrelated procedure or service by the same physician during the postoperative period) may apply. Although each has a distinct purpose, the similarities among these modifiers can make distinguishing them from one another and applying them properly particularly challenging.
Note: Major surgeries, including most neurosurgical procedures, include a 90-day global period.
Modifier -58: Related and/or Anticipated Procedure
According to CPT, modifier -58 is applicable when a procedure or service during the postoperative period is:
a) Planned prospectively at the time of the original procedure (staged);
b) More extensive than the original procedure; or
c) For therapy following a diagnostic surgical procedure.
In each case, the subsequent procedure or service is either related to the underlying problem/diagnosis that prompted the initial surgery or anticipated at the time the initial surgery is performed (or both), says Sharon Tucker, CPC, president of Seminars Plus, a consulting firm specializing in coding, documentation and compliance issues, in Fountain Valley, Calif. The patient's condition, rather than the results of a previous surgery, dictates the need for additional procedures: Modifier -58 should not be used if subsequent procedures are needed due to surgical complications or unexpected postoperative findings that arise from the initial surgery (see below for modifier -78).
A return to the OR is not required to append modifier -58. The postoperative procedure or service may, for instance, be provided in the physician's office or other outpatient setting. In all cases, however, the same physician must undertake both services/procedures.
Most commonly, modifier -58 is used to indicate that a staged procedure, i.e., more than one session generally operative is required to complete the procedure. For instance, a patient has surgery to remove a lesion from the base of the skull, and secondary repair of the dura is necessary to arrest the loss of cerebrospinal fluid. The surgical approach, lesion removal and primary closure (61580-61598 and 61600-61616, as appropriate) are performed during a single, extended operative session. The secondary repair, planned prospectively during the first session, generally occurs days later. This subsequent session would be reported 61618 (secondary repair of dura for CSF leak, anterior, middle or posterior cranial fossa following surgery of the skull base ...) with modifier -58 appended to indicate a staged procedure.
In a second [...]
