what modifer is correct?

herrera4

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pt had a THD procedure done for hemmorhoids but came back in about a week-

INDICATIONS FOR PROCEDURE: The patient is a ......gentleman who has undergone a hemorrhoidopexy on 5/18/2012. He was fairly straining while having a bowel movement, felt something "give" and presented to the office yesterday with the cubic prolapsed left lateral hemorrhoidal group with excruciating pain. For pain control is now admitted for hemorrhoidectomy.

which would be the correct modifer to use for this surgery?? its not a complication from the first surgery but not totally unrelated?

tia
 

Lujanwj

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Take a look at -58. Based on CPT description of modifier stating "(b) more extensive than the original procedure".
 

herrera4

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ok-when i was looking at -58 im thinking of, a procedure that we know the patient will have to come back like an IRC and the patient was booked for procedure.....in this case he wasnt so I comepletely overlooked this one--thank you
 

LLovett

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I think 78 is more appropriate

78- Unplanned Return to the Operating/Procedure Room by the Same Physician or Other Qualified Health Care Professional Following Initial Procedure for a Related Procedure During the Postoperative Period

Laura, CPC, CPMA, CEMC
 

Lujanwj

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-58 Staged or Related procedure or service .....: It may be necessary to indicate that the performance of a procedure ... was (B) more extensive than the original procedure;

Be careful of assuming because it was unexpected it's automatically -78. Modifier -58 helps to represent that the Dr tried a less extensive procedure before the extensive hoping that the lesser would be enough.

An -ectomy is usually more extensive than a -pexy and in this case they are both related. Given that, I would try -58. That will reset the 90 day global and reimburse at 100%. This is an arguable situation but if documented correctly it shouldn't be a problem. Lastly, if you are calling it a complication -78 you won't be able to bill for it unless the DR did it in the OR or a certified procedure room. If not, it's considered global.
 
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Lashel

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Very interesting point about modifier 58. The procedure does not have to be a planned return to the OR to be staged, and you absolutely can use modifier 58 to report that you went back and had to do something more extensive than the first procedure.

However, in appendix A under the note for modifier 58 is states "for treatment of a problem, that requires a return to the OR (eg: unanticipated clinical condition see modifier 78).

So I think the question is this: Is this an unanticipated problem that occured (modifier 78), or did the prior procedure (less extensive) fail or fail to provide adequate results, so you went back and did something more extensive (modifier 58). Depending on how your physician documented, and how you answer that question, I think that determines if you use modifier 58 or 78.

Lashel Church, CPC, CPC-I, CEMC
 
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