Mod 58 or 78??

Birdie625

Networker
Messages
67
Location
Millers Falls, MA
Best answers
2
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 would agree with you, 78 is more appropriate, for the reasons you list. CMS also states in the Global Surgery Booklet that modifier 78 is correctly used when treatment for complications requires a return trip to the operating room. Yes, the fact that modifier 58 restarts a global period can make a difference, but it is a minor one (in this case you are only talking about 3 days), and in fact, some payers adjust the payment for modifier 78 to reimburse only intraoperative costs, which compensates for this and makes it a wash. In either case, I would not worry about this difference as it is minor.

Regarding facility claims, they are not subject to any global surgical rules, so they have no need for the global period modifiers. In some cases, you might see a modifier 78 on a facility case where a patient was returned to the operating room on the same day and they may use this to show that a normally bundled procedure was performed in a separate operative session that same day.
 
Thank you Thomas for your explanation and to my curiosity question as well. Hopefully, soon, I will gain confidence in myself and be able to make a point instead of rolling over. Thanks much again. (Ps thank you for mentioning the global booklet...I forgot to use that as a source for my search..lesson learned!)
 
Top