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Can modifier 58 be used w/radiology codes?

  1. Default Can modifier 58 be used w/radiology codes?
    Medical Coding Books
    Hello All,

    I need help!

    Recently one of our surgeons has requested that we start using modifer 58 for the post operative X-Ray on closed reduction procedures.

    It is my understanding that we would use the radiology cpt code with 2 units. My thought is, when listing a closed reduction cpt code, the insurance companies would understand that there is a pre-operative X-Ray to determine the fracture, & then the post-operative X-Ray to verify that the bones were set properly.

    Modifier 58 states, "Staged or related procedure or service by the same physician during the postoperative period". Is a diagnotic lab (X-Ray) considered a procedure or service?

    Please help!

  2. Default Nope
    First let me say that radiology is not in any way my expertise...

    Unfortunately, I do not have the actual documentation to support this... What I have always been taught and practiced was that a procedure (post-op x-ray) to confirm the completion of another procedure (closed fracture reduction) is included as an integral part of the primary procedure.

    If anyone out there has documentation to support or prove this wrong, please let me know!!

    I hope this helps!

  3. #3
    normally, -58 should only be used with surgery codes. when they say "staged or related procedure or service", usually they're talking about a procedure that is being repeated during the global period, or a more extensive procedure related to the original. two examples of this are:
    1. multiple debridements on consecutive DOS (after a severe abdominal wound, or traumatic amputation), or walking a skin flap from one location to another


    2. if the closed reduction had not worked, performing ORIF or another more extensive fracture care procedure (this is more extensive than closed reduction)

    if it's the same x-ray being done on the same DOS, by the same physician, you could use modifier -76 to show that it's a repeat procedure. although the above poster may be correct in saying that the confirmation x-ray is included in global, you might just have to try the -76 and see what your carrier does with it. if there's a denial, ask why? hope this helps!

  4. Default
    Thank you both very much for your help!

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