Friday, June 4, 2010

A staged or related procedure or service - Modifier 58

Part - A  Level I Modifiers - 58

Description A staged or related procedure or service by the same physician during the post-operative period of a previously performed procedure.
Required for Claims Hospital Outpatient Prospective Payment System (OPPS)
Type of Bill: 12x, 13X
Coding Guidelines Generally, this modifier applies to surgical procedures (10000-69999) but may apply to some diagnostic services (CPT 90281-99569)
General Guidelines

A. The “post-operative period” indicated in the description of this modifier refers to procedure or services performed in the same calendar day.

B. In order to use this modifier appropriately, the staged or related procedure should be planned at the time of the original procedure.

C. The staged or related procedure must be more extensive than the original procedure.

D. Modifier –58 would be appropriate for therapy following a diagnostic surgical procedure (again this would apply if the therapy was provided in the same calendar day).

E. Do not use modifier –58 to report the treatment of a problem that requires a return to the operating room (unplanned). (Refer to modifier -78).

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