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Thread: Post Op Complications

  1. #1

    Default Post Op Complications

    AAPC: Back to School
    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)

  2. #2

    Default Post Op Complications

    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

  3. #3


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

  4. #4
    Join Date
    Apr 2007
    St. Louis, Missouri


    Does anyone know if there are certain criteria that have to be met in order for you to consider the room a surgical suite?

    Melissa Blow, CPC

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