Birdie625
Networker
Hi - I do the pro-fee Ortho charges. Pt has surgery for ruptured quad tendon (we used 27385, but are now being told it should have actually been an unlisted cpt instead --a different issue). 3-days later, pt falls and the prior surgery fails (incision reopens, prior quad fix fails). Dr takes pt back to OR to re-do what they did prior. I say mod 78; a co-worker says 58. The comment to me was: """I did not choose 78 because this is not an unplanned return for a complication. Is it a problem because the patient fell again. Modifier 58 restarts the global period and it makes a difference.""""
I say 78 as it was not staged (but it was related-58); Return to OR for complication (granted 58 could be used here as well?); It was not planned/anticipated (58); not for therapy (58); nor more extensive than the 1st surgery (58).
The more I read/research, the more confused I am getting. Reading another source it mentions: unanticipated condition / return to the operating or procedure room / use modifier 78, not modifier 58 (I have bolded)
Questions: 1) 78 or 58 for the Pro-Fee claim.
2) I am not familiar w/how modifiers of this nature affect the UB Facility 'technical' charges; Do the facility coders need to append this type of mod on their charge? <--This is just a curiosity question.
Thank you all for your time and consideration to comment. Birdie
I say 78 as it was not staged (but it was related-58); Return to OR for complication (granted 58 could be used here as well?); It was not planned/anticipated (58); not for therapy (58); nor more extensive than the 1st surgery (58).
The more I read/research, the more confused I am getting. Reading another source it mentions: unanticipated condition / return to the operating or procedure room / use modifier 78, not modifier 58 (I have bolded)
Questions: 1) 78 or 58 for the Pro-Fee claim.
2) I am not familiar w/how modifiers of this nature affect the UB Facility 'technical' charges; Do the facility coders need to append this type of mod on their charge? <--This is just a curiosity question.
Thank you all for your time and consideration to comment. Birdie