Wiki FX care - 2nd request please

[orthopaedic01]

A patient came into the orthopaedic office with a lumbar compression fracture. The office visit is coded with closed treatment, 22305, POS is OFF.
One month later the patient had to have lumbar surgery, fusion, decompression, etc. POS is Inpatient. My question is: Does this surgery need a modifier? It is within the global of the office visit of fracture care, but I'm not sure it matters.
Modifier 78 wouldn't work in my opinion because it is meant for "return" to operating room. The original treatment was in the office and not an operating room so I do not feel 78 would be used. Additionally, this surgery was not a complication of the closed treatment (22305).
Mod. 58 is the only thing I'm considering. I'm split in half though, because I do not feel the actual surgery was a "staged" procedure. However, you could make the arguement that it is a "related" procedure. Opinions? Thanks!

 

[RGALVEZ]

You would still use modifier 78 because if you look at the explaination for the modifier, it says "Unplanned return to the operating/procedure room. Place of service is not the cause for usage of the modifier, but the timing (when it occurred) of the procedure itself. Just my interpretation of this modifier.

 

[Bella Cullen]

My opinion is if the doctor knew he/she was taking this pt to the OR (they discussed the surgery before) for this surgery then I would use 58 modifier. The way I interpret 78 mod is when the pt has to go to the OR right away for example a post op complication, that was not discussed prior.
Hope that helps.

 

[Lisa Bledsoe]

I would use -58. Look at the description in Appendix A of your CPT. It states -58 is used to report a more extensive procedure than the original, etc. I think of -78 as more of an uh-oh kind of modifier, where -58 would indicate that the second procedure could have been expected. Hope that helps.