Medical Billing Blog

Tips For Use Of Modifier 58 and Modifier 78 In Medical Billing

Posted by Ali Ziehm on Thu, Mar, 08, 2012 @ 12:03 PM

Going back to Surgery Modifier 58 & 78By Christine Moore, CPC, CGSC--Even though Modifier 58 and Modifier 78 have similar meaning and wording, there are a few tips that will help in choosing the correct global period modifier when billing claims.

Modifier 58

Staged or Related Procedure by same physician during postoperative period.

Modifier 58 would be used when the follow up procedure is from a condition or problem due to the initial procedure planned or not, or the second procedure is the next stage of the treatment for the condition.

CMS guidelines for the use of modifier 58:

  • Planned at time of original procedure

  • More extensive than the original procedure

  • Therapy following a surgical procedure

  • Reapplication of a cast within the 90-day global period

  • The global period will restart when reporting modifier 58

  • Reimbursement is not affected

Modifier 78

Unplanned Return to Operating Room during postoperative period—Related Procedure

Modifier 78 would be used when the patient suffers from a complication from the original surgery and requires an “unplanned” return to the OR.  Keep in mind that a complication is a different condition than the problem that prompted the original surgery.

  • The global period will not restart when reporting modifier 78

  • Reimburse will be reduced about 15 to 30 percent.

Note:  Do not use modifier 78 if the patient’s second surgery is not related to the original complication or problem.  In this case, you should refer to modifier 79, unrelated procedure or service by the same physician during the postoperative period.

Christine Moore, is an AAPC Certified Professional Coder and Certified General Surgery Coder who has been doing medical billing and coding for over 10 years.