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Modifier 58 - Please help

  1. #1
    Default Modifier 58 - Please help
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    Please help. I am getting alot of conflicting information on modifier 58 vr 78. I have a Wound Care physician that is doing a Oasis dermal replacement (CPT 15430) In his dictation he states that this is the first of a planned stage series. The problem is our billing dept is billing this cpt code with a 78 modifier every time he does this procedure and I think it should be billed with a 58 modifier, but my question is that if these staged procedure are billed with the 58 modifier will the provider be reimbursed or is this for just informational information and I was also told that this now starts the global period over. I thought the global was started over when billed with the 78 modifier and reimbursement is done with the cpt code billed with a 78 modifier. I hope this is not too confusing but at this point that is exactly what I am. Thanks

  2. #2
    Albany, New York
    CPT book answers this question for you.

    Description of Modifier 78--Unplanned Return to the Operating Room/ Procedure Room by the same physician following initial procedure for a related procedure during the Post-Op period.

    If you doctor is telling you up front that this procedure will be staged, your choice is "58".

    Also, please refer to the attachment info from CPT Assistant:
    Attached Files Attached Files
    Karen Maloney, CPC
    Data Quality Specialist

  3. #3
    I bill for OASIS almost once a week. Cpt 15430 (+58 modif for second and all other series) and Q4102 (21 units). Cpt 15430 has 90 days global, so you have to use 58 and each time you bill 15430 you start new 90days global. No worries about reimbursement. You'll get the payment.

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