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Modifier 58 vs. 79

  1. #1
    Default Modifier 58 vs. 79
    Medical Coding Books
    A patient was seen on DOS 10/11/10 for a lithotripsy for rt renal calculus and then returned on DOS 10/15/10 for a additional lithotripsy for residual fragments and bladder calculi.

    For DOS 10/11/10 it was billed as

    For DOS 10/15/10 it was billed and denied for included in primary procedure

    For DOS 10/15/10 can you bill a modifier 58 because it is related to the primary procedure. We are having a debate in the office over the use of 58 vs. 79. Can someone please help shead light on this.

  2. Default Modifier 58 vs. 79
    If the documentation indicates the patient was informed that additional surgery for remaining stone fragments may occur you would certainly be able to use mod 58.

    If there is no discussion (documentation) about a possible return trip to the OR in that case I would use mod 78 because the condition is related.

  3. #3
    Thank you!!!!

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