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Modifier 58 or 76 or 78

  1. Arrow Modifier 58 or 76 or 78
    Medical Coding Books
    Hi,

    In the ASC arena, a patient came in for a nerve root injection. The MD discussed with the patient the possibility of taking the patient back to the OR to perform an injection at a different level if the first one was not successful. The injection was performed and the patent taken to the recovery room. After a discussion the the patient in the recovery room, the MD took the patient back to the OR to perform another injection at a different level. Which modifier is appropriate and why?

    Thanks!!

  2. #2
    Location
    St George, UT
    Posts
    37
    Default
    What were the levels injected and what injection was documented? Was it a selective nerve root block/transforaminal injection? If so, I would use 64483 for the first level and 64484 for the 2nd injection.

  3. Default
    If I remember correctly, the first trip to the OR was documented as T10 intercostal nerve (64420) and the second trip was T11 intercostal nerve (64420).

  4. #4
    Default
    If the CPT code 64420 is correct , which I'm questioning because you state "nerve root" injection and 64420 is a relatively non invasive block, then I would use the -76 modifier (repeat procedure). The -58 and -78 modifiers are not appropriate as CPT 64420 has no global period. I would also not consider 64421 (multiple levels) because they were performed at separate settings.

    Julie, CPC

  5. #5
    Location
    ENGLEWOOD/DENVER
    Posts
    2,338
    Default
    since this is a return to the OR on the same date of service, you are an ACS, he injected a totally different level, then I would use the 59 modifier.

    I would not use the 58 because it was not staged or planned at the time of the original injection to return the patient to OR (in other words not scheduled).

    Since its a different level, 78 would not be appropriate either.

    Mary, CPC, COSC

  6. #6
    Location
    Duluth, Minnesota
    Posts
    1,133
    Default
    I agree with mbort - I'd be using a .59 modifier on the second code.
    (nicely explained!)
    Donna, CPC, CPC-H

  7. #7
    Default
    I agree the -59 modifier is also appropriate, however, I've had carriers still deny the second block, same CPT code (different level) with the -59 modifier stating that since the CPT does not specify exact level that the -76 modifier is necessary to pass the edits.

    Julie, CPC

  8. Default
    Thanks for your help.

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