I have a request for a refund on my desk for a patient who had a axillary node bx (38525 & 38792) abou 14 days after an excision an excision of breast lesion (19125). I used a 78 modifier because the op-note doesn't specify that the bx was a planned return to the OR, however I do see how it could be necessary to use a 58. We can't determine if the patient was going to return to OR until the results from the lesion removal are back. I'm interested to see what others think if they would use a 58, 78 or even something else. Should I appeal this?