Wiki Global Period Modifier

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neelaprakash

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We billed CPT 36558 on 9/11 and 9/14 patient came back in and we billed 49406 & 10160

Per Medicare guidelines, procedure code 10160 is within the global period of procedure code 36558 found on history performed on 09/11/2025 by the same provider. Review documentation to determine if a modifier is appropriate
Per Medicare guidelines, procedure code 49406 is within the global period of procedure code 36558 found on history performed on 09/11/2025 by the same provider. Review documentation to determine if a modifier is appropriate.

Is 49406 and 10160 global to 36558? Can 49406 and 10160 be billed with a Modifier? I am leaning towards MOD 58.
Looking for correct guideline.

Thank you in advance.
 
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neelaprakash said:
We billed CPT 36558 on 9/11 and 9/14 patient came back in and we billed 49406 & 10160

Per Medicare guidelines, procedure code 10160 is within the global period of procedure code 36558 found on history performed on 09/11/2025 by the same provider. Review documentation to determine if a modifier is appropriate
Per Medicare guidelines, procedure code 49406 is within the global period of procedure code 36558 found on history performed on 09/11/2025 by the same provider. Review documentation to determine if a modifier is appropriate.

Is 49406 and 10160 global to 36558? Can 49406 and 10160 be billed with a Modifier? I am leaning towards MOD 58.
Looking for correct guideline.

Thank you in advance.
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It sounds like you may be trying to choose a modifier based solely on the CPT codes, but that’s not how modifier selection works.

You’ll need to review the documentation to determine why the services on 9/14 were performed. Only then can you know what modifier would be appropriate.

What’s leading you to consider Modifier 58? Did the provider clearly document that these were planned or staged procedures? Or were the services related to unexpected complications instead?
 
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It was not Documented as staged or related, instead a result of post op complications. I tried MOD 78 unplanned return to procedure room, and we received a rejection for that too.
 
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Even though 49406 and 10160 have 0-day globals on their own, they occurred within the 10-day global period of 36558 (from 9/11 to 9/21).
So, Medicare will initially bundle them unless you use an appropriate modifier and documentation supports it.
if planned follow-up, drainage as part of catheter management - Mod 58
When the patient returns for a related but unplanned procedure due to a complication (e.g., abscess, hematoma from CVC) ex: drainage of abscess at catheter site - Mod 78
When procedure is unrelated and at a different anatomical site ex: unrelated abscess drainage in abdomen while CVC site is healing - mean If unrelated site or new problem - Mod 79.

on priority
You must determine why the drainage was done
 
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