Post Op Complications

KIMBERLY44

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Patient Had A Surgery With 90 Post Op Days, Patient Has A Complication And Returns To The Office For A Wound Abscess Drainage, Is Anyone Using A Modifier 58 On This Scenario For Medicare Or Private Carriers? (-58 For Therapy Followng Diag Sg Procedure)
Thanks
 

LeslieJ

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IMHO -58 modifier isn't appropriate for the initial treatment of a surgical complication; this modifier is for subsequent, staged (preplanned), more extensive types of procedures. Think of it this way: First this, then that.

In 2008 CPT take a look at modifier -79; the wording has changed to not only include "return to OR" but also "or treatment room" (I'm paraphrasing because I don't have a CPT book with me at this moment).

I would check this to see if it's more appropriate to use for your case.

Example Scenario: if the initial treatment of the complication included the I&D for abscess, and then the patient was told to return in 3 days for another I&D, the procedure for the 2nd I&D is "preplanned" and the -58 modifier can go on the 2nd I&D procedure.

L J
 

KIMBERLY44

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Modifier 78 Now States Procedure Room, But Cms (medicare)
Has Clarified That As A Surgical Suite, Etc.
 
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