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Modifier 58 - One of our ortho clinics

  1. #1
    Default Modifier 58 - One of our ortho clinics
    Medical Coding Books
    One of our ortho clinics has a question about the use of Modifier 58 for joint injections post arthroscopic knee surgery. The patient had an arthroscopic knee procedure and one week later had continued pain so the dr injected the knee with Xylocaine and a steroid. The question is can this be billed? I feel that it cannot, as it is post-op pain management and the dr says it is related to the surgery and therefore a modifier 58. Does anyone have any suggestions or solutions to this. Thanks, Lynn

  2. #2
    We had this same discussion but what we found is that you are correct. The injection after surgery does not meet the guidelines for 58. (Show them the description in appendix A) We asked a well known speaker for orthopedics at one of her audio conferences and this is the answer she gave. We also had payors deny this as part of the global service. Hope that helps.

  3. Question Modifier -58
    Going one step further and in more detail -- if the patient had a scope for medial meniscetomy and osteoarthritis, knowing that this is not a cure for osteoarthritis and that the osteoarthritis will still be present, if the patient comes in during the global period and has pain, and the doctor identifies it as due to the osteoarthritis, is the injection now for a "different" purpose other than postop pain and can it be billed? Should it have a -58 modifier as the surgery was for osteoarthritis and so is the injection? Or would -79 be more appropriate as the injection is not for postop pain but for the underlying condition?

    I would love to know how to properly code this scenario. Thank you
    Mary Baierl, CPC, CCA, CMT

  4. Default Modifiers
    Here is a good link for a FREE audio conference on Modifiers by DARLENE BOSCHERT, CPC, CPC-H, CMT, CHP, CMA. You will also receive the 1 AAPC CEU Credit for listening to this audio.

    Hope this helps

    Nichole Anderson CPC

  5. #5
    I wouldn't think 79 would be appropriate if the injection is for osteoarthritis and part of the surgery was for osteoarthritis - 79 means unrelated. Now if the surgery was only for a meniscus tear and the injection is for osteoarthritis, then maybe 79 would be appropriate? (Don't quote me on this).

  6. Default Cryotherapy
    Can we use 58 for cryotherapy or mostly it is for major surgeries?
    If on first visit physician says " pt will return at 2-4 week interval for retreatments as needed," does it justify usage of modifier 58 when the pt show up during 10 day global period?

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