Practice Management Alert

Question: I'm not clear on the ways modifier -58 can be used, and keep getting denials. Can you explain when and how to use this modifier?
    
North Carolina Subscriber

Answer:  Modifier -58 often leaves billing offices in surgical practices pulling their hair out in frustration, but you can escape this fate by learning the basics.
 
This modifier indicates a "staged or related procedure or service by the same physician during the post-operative period," and is used most often by ophthalmologists, plastic surgeons and orthopedic surgeons, says Quin Buechner, MS, M.Div, CPC, CHCO, president of ProActive Consultants in Cumberland, Wis. And all in all, "it's a big pain in the rear," he laments.
 
The problem is that many providers don't understand that there are technically three ways you can use -58, says Margie Vaught, CPC, CCS-T, an independent consultant in Ellensburg, Wash.:

 1. It can be used to indicate a planned, or staged, procedure (such as a serial debridement).
 2. It can be used to show a more extensive procedure following a less extensive one (such as excising a toe for gangrene and later having to remove the entire foot unexpectedly).
 3. It can be used to indicate a diagnostic procedure followed by the therapeutic procedure (such as a patient coming in for a bronchoscopy and then finding out she needs a thoracotomy).

 The biggest mistake people make with modifier -58 is assuming they can't use it if the surgeon didn't plan to do the procedures, Vaught notes. "Well, that's not the only thing the modifier is for," she reminds providers.