Wiki 10060-76 or -78

[Knm5800]

My physician perfomed an I&D on a pediatric patient, billed 10060. Child returned 2 days later when abscess continued oozing. Physician performed a 2nd 10060 to same area.

Since this is in the 10 day global period, I am not sure if I should use -76 for repeat procedure or -78 for unplanned return to procedure room.
This is a MCD patient, not even sure if either modifier will get the 2nd I&D paid.

Any suggestions?

 

[LeslieJ]

Modifier 58 vs. 78 - not modifier 76

Hi,

You wouldn't use modifier 76, instead look to the documentation to tell you whether or not modifiers 58 or 78 apply.

If there was even a hint that further treatment would be necessary 2 days later, modifier 58 - as a staged/planned procedure may be best.

If the patient returned and this was an unexpected complication/event, then look at the descriptor for modifier 78. This may be best.

Did the MD know or anticipate a 2nd I&D would be needed or not? Documentation is key; it should lead you to the correct modifier(s) to use.

Leslie Johnson, CPC