Wiki Appropriate use of modifier 58

[abill_423]

Can someone help clarify the appropriate use of modifier 58 as it pertains to "therapy following a surgical procedure"? I have a patient who had a meniscectomy and chondroplasty for left knee DJD and degenerative medial meniscal tear. One month later the patient returns to the office for his post op visit and it is noted that he has moderate effusion of the left knee so the provider aspirates 90 cc of fluid from the knee and injects steroids into the knee. Would it be appropriate to report the arthrocentesis (20610) with modifier 58 or is this procedure considered global to the previous surgery?

Thanks to all who reply.

 

[Lujanwj]

I'd clarify whether or not this is staged (anticipated -58) or a complication (unanticipated condition -78). Basically, if it was expected that the patient would return for the procedure, it's -58. If the procedure was unexpected, -78

In order to bill for it with -78 the procedure must have been done in the OR or certified procedure room. If not performed in either, it will be considered global.

 

[abill_423]

Thank you for your reply. This was not a staged procedure according to the documentation. Maybe an unanticpated condition but the patient was not returned to the OR or a procedure room so modifier 78 is not appropriate. I do think that this is part of the global but it made me question the appropriate use of this modifier.

According to CPT modifier 58:

Staged or Related Procedure or Service by the Same Physician During the Postoperative Period: It may be necessary to indicate that the performance of a procedure or service during the postoperative period was (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. This circumstance may be reported by adding modifier 58 to the staged or related procedure. Note: For treatment of a problem that requires a return to the operating or procedure room (eg, unanticipated clinical condition), see modifier 78.

I understand (a) planned or anticipated and (b) more extensive than the original procedure. I'm just not clear on when "(c) therapy following a surgical procedure" would be applicable. Does anyone have any examples that they could share?

Thanks again to all who respond.

 

[Lujanwj]

The "therapy" portion means it's part of the care plan. The Dr's plans for the patient to return for additional procedures/therapy.

Example:

Dr is doing a 90 day global procedure, 14 days after the procedure the Dr's care plan dictates that the patient will returns for another procedure /therapy. To pull that procedure out of the global period you would use modifier -58 to indicate that the procedure was part of the care plan/staged.

When using -58 for this the documentation must support that the procedures were planned in advance or they are the standard of care.

Hope that helps