Wiki Revised question: Modifier 58 or 78

[davidskm]

Using modifier 58 vs 78.
Initial surgery was 35355(Thromboendarterectomy) & 35566 (fem-tib vein bypass graft). Pt comes back to OR for large area of debridement's almost weekly due to an skin infection. For all the debridement surgeries would you code them with a 58 or a 78 attached due to the initial surgery which has a 90global? The notes do not state anything was planned about taking the patient back to OR for any of these services so they were unplanned. One opinion is that 58 is "related/extensive" so it should be used but since this technically isn't on same location or initial problem (vessels) so thoughts are to use modifier 78. Any recommendations?

 

[such78]

Using modifier 58 vs 78.
Initial surgery was 35355(Thromboendarterectomy) & 35566 (fem-tib vein bypass graft). Pt comes back to OR for large area of debridement's almost weekly due to an skin infection. For all the debridement surgeries would you code them with a 58 or a 78 attached due to the initial surgery which has a 90global? The notes do not state anything was planned about taking the patient back to OR for any of these services so they were unplanned. One opinion is that 58 is "related/extensive" so it should be used but since this technically isn't on same location or initial problem (vessels) so thoughts are to use modifier 78. Any recommendations?

Modifier 78 unplanned return to the operating room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period indicates treatment of a problem or condition created by the initial surgery. In other word, the initial surgery creates a complication that requires the surgeon to bring the patient back to the operating room unexpectedly to repair/correct the complication.


Example:

A patient undergoes a gastric bypass (90-day global period) in January. In march, the patient returns to the operating room for an incisional hernia repair that developed at the site of the bypass incision. In this case, you would append modifier 78 to the procedure code for the repair of the incisional hernia because the hernia was a complication from the initial surgery .


Modifier 58 Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period to indicate an expected return to the operating room to complete a procedure in stages. Modifier 58 may be used to indicate a procedure that is:

1. Planned or anticipated (staged);
2. More extensive than the original procedure; or
3. For therapy following a diagnostic surgical procedure

Example:
A patient undergoes a breast biopsy on March 2 and a modifier radical mastectomy on March . In this case, you would add modifier 58 to the procedure code for the modified radical mastectomy.



From AAPC monthly subscription.

 

[such78]

Modifier 78 unplanned return to the operating room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period indicates treatment of a problem or condition created by the initial surgery. In other word, the initial surgery creates a complication that requires the surgeon to bring the patient back to the operating room unexpectedly to repair/correct the complication.


Example:

A patient undergoes a gastric bypass (90-day global period) in January. In march, the patient returns to the operating room for an incisional hernia repair that developed at the site of the bypass incision. In this case, you would append modifier 78 to the procedure code for the repair of the incisional hernia because the hernia was a complication from the initial surgery .


Modifier 58 Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period to indicate an expected return to the operating room to complete a procedure in stages. Modifier 58 may be used to indicate a procedure that is:

1. Planned or anticipated (staged);
2. More extensive than the original procedure; or
3. For therapy following a diagnostic surgical procedure

Example:
A patient undergoes a breast biopsy on March 2 and a modifier radical mastectomy on March . In this case, you would add modifier 58 to the procedure code for the modified radical mastectomy.



From AAPC monthly subscription.

So Mod 78 is applied to your case.

 

[mk2001]

Using modifier 58 vs 78.
Initial surgery was 35355(Thromboendarterectomy) & 35566 (fem-tib vein bypass graft). Pt comes back to OR for large area of debridement's almost weekly due to an skin infection. For all the debridement surgeries would you code them with a 58 or a 78 attached due to the initial surgery which has a 90global? The notes do not state anything was planned about taking the patient back to OR for any of these services so they were unplanned. One opinion is that 58 is "related/extensive" so it should be used but since this technically isn't on same location or initial problem (vessels) so thoughts are to use modifier 78. Any recommendations?

Mod 78 is what we use also.