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Mod 78 or Mod 58

S

skorkfranks

Guru
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107
Location
Richwood, NJ
In the case of an office visit that takes place during the post op period, if the patient has a procedure (e.g. arthrocentesis of knee after knee replacement surgery) would Mod 58 be the appropriate modifier to use? Or is Mod 78 correct?
 
Sorry, hit the button before I finished my thought. Or is the procedure considered part of the 90 day global? I'm trying to help resolve an office debate. Thanks.
 
I would say neither for an arthrocentesis....

We've used -25 on the OV code with success in the past for an arthrocentesis simply because we've never planned on doing it (that I know of) and we did it in the office, not OR.
 
as far as whether it is part of global depends on the payer definition of what is included in the global, Medicare has their version which you can find in the Mcare policy manual, and then there is the definition in the CPT code book, and then each payer may have a different version but be sure it is in writing. IF it is allowable to bill this, it will be the 78 modifier as this is an unplanned procedure, the 58 is for a planned procedure. you will not have an E&M since it is in the global.
 
skorkfranks said:
In the case of an office visit that takes place during the post op period, if the patient has a procedure (e.g. arthrocentesis of knee after knee replacement surgery) would Mod 58 be the appropriate modifier to use? Or is Mod 78 correct?
Click to expand...

78 would be for return to OR and since was done in the office 78 would not apply. Was it planned?
 
right but most 20610's are performed in an office setting. Another point would be that it's very difficult to report 20610 in global as it is usually performed to aleviate post-op pain. Most likely that 20610 would be considered part of 99024.
 
We code w/58 showing it is RELATED. 78 would be coded if the pt was returned to the OR/PROCEDURE ROOM. We have always interpreted this modifier as "STAGED or RELATED Procedure" as it states in CPT. Wouldnt it be considered for therapy following a surgical procedure?? We have discussed this many times... an outside opinion would be beneficial! :confused:
 
moodymom said:
We code w/58 showing it is RELATED. 78 would be coded if the pt was returned to the OR/PROCEDURE ROOM. We have always interpreted this modifier as "STAGED or RELATED Procedure" as it states in CPT. Wouldnt it be considered for therapy following a surgical procedure?? We have discussed this many times... an outside opinion would be beneficial! :confused:
Click to expand...

We never did. There's a great Pink Sheet Article by Margie Vaught that uses this example.
 
the basic difference between these 2 modifiers is the 58 is for a procedure that was planned ahead of time, and the 78 is for an unplanned return.


...that's exactly how I interpret those modifiers.
 
Our office doesn't bill for arthrocentesis and/or injections done during a global period when it's done on the same site that was operated on. We had this debate a couple years ago and my CPC instructor at the time stated it is considered for post op pain management and is part of the global package. It came up again just a few months ago and our auditor got involved and she said it would be inappropriate to bill an injection or arthrocentesis during the global when done at the site that was operated on.
 
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