Page 1 of 2 12 LastLast
Results 1 to 10 of 12

question

  1. Red face question
    Exam Training Packages
    hello,
    I was wondering if dr did fracture care on 11/11/09 with no plans for surgery, then comes back again for an xray on 12/16/09 and then decides patient needs surgery (ORIF) on 12/30/09. Is the initial fracture care still billable and the surgery is billed with a 58 modifier?
    Not sure, any input is appreciated.
    Thanks,
    Melissa, CPC

  2. #2
    Location
    Greeley, Colorado
    Posts
    2,045
    Default
    Yes, fracture care for the November visit and surgery with mod -58 in December would be appropriate.
    Lisa Bledsoe, CPC, CPMA

  3. Default
    Thank you!!

  4. #4
    Location
    Duluth, Minnesota
    Posts
    1,133
    Default
    Hi...I agree with Lisa...yes, the initial fracture treatment is billable...
    however - I have to disagree with Lisa...no modifier .58 is needed... it would only be needed IF the surgery fell within the global (day before/day of) surgery - but the initial care was in November... the decision for surgery was days/weeks later....

    Donna, CPC, CPC-H

  5. Default
    Quote Originally Posted by dmaec View Post
    Hi...I agree with Lisa...yes, the initial fracture treatment is billable...
    however - I have to disagree with Lisa...no modifier .58 is needed... it would only be needed IF the surgery fell within the global (day before/day of) surgery - but the initial care was in November... the decision for surgery was days/weeks later....

    Thanks for your input. I think you're thinking of mod 57 decision for surgery. I'm saying 58 on the surgery code for related to procedure in global.
    Thanks again,
    Melissa,CPC

  6. #6
    Location
    Duluth, Minnesota
    Posts
    1,133
    Default
    !!!! thanks Melissa!! you are correct! that's what I was thinking...57...

    aaaaaand.... lol..then yes...I agree with Lisa on all points! AND YOU!

    thanks again!!
    Donna, CPC, CPC-H

  7. Default -57 vs. -58
    I'm thinking that perhaps the -57 be appended to the E&M for the date of service that resulted in the decision for the surgery and the -58 be appended to the actual surgery when it takes place...

    Anyone agree?

  8. #8
    Location
    ENGLEWOOD/DENVER
    Posts
    2,338
    Default
    might as well as my two cents.

    yes the initial care is billable from the November DOS

    I dont think 58 is the appropriate modifier for the Dec DOS. This procedure is not "staged" (only related)

    I think 78 is the more appropriate modifier on the 2nd surgery as the patient was treated for the fracture, now the fracture has migrated (a complication) and now the patient is being taken back for additional treatment.

    my two cents
    Mary, CPC, CANPC, COSC

  9. #9
    Location
    Greeley, Colorado
    Posts
    2,045
    Exclamation Modifier -58
    I say -58 because the original fracture care was not enough, therefore a more extensive procedure is being performed...modifier -58. Modifier -58 does not only mean "staged", but also "more extensive than the original procedure".
    Lisa Bledsoe, CPC, CPMA

  10. #10
    Location
    ENGLEWOOD/DENVER
    Posts
    2,338
    Default
    at what point do you report that this was a complication (78)?

    Improper use of the 58 can lead to audits. I would highly recommend research on the use of 58 versus 78 to prevent audit/refund/OIG issues.
    Last edited by mbort; 01-07-2010 at 03:42 PM.
    Mary, CPC, CANPC, COSC

Page 1 of 2 12 LastLast

Similar Threads

  1. ROS Question and Exam Bullet Question
    By Stefanie in forum Auditing General Discussion
    Replies: 1
    Last Post: 05-21-2010, 05:04 PM
  2. Replies: 5
    Last Post: 10-13-2008, 08:55 AM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •  
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?

Login

Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.