Saturday, December 4, 2010

rule for appliying modifier 58 with example


Modifier 58 – Staged/related procedure by the same physician during a postoperative period


The following rules apply:

   
* Apply modifier 58 to surgical procedures that were (a) planned or anticipated at the time of the original surgery, (b) more extensive than the original procedure, or (c) for therapy following the original procedure.

    * The new surgical procedure usually involves a new CPT® or HCPCS code.

    * Do not apply modifier 58 to procedures whose definitions include the description “one or more sessions” (such as, 67105) if the subsequent sessions are performed during the postoperative period of the initial session. Modifier 58 may only be used with these types of procedure if a subsequent session is performed outside of the postoperative period of the original procedure.
    * The planned surgical procedure starts a new global period.
    * Do not report modifier 58 with modifiers 78 or 79.
    * Modifier 58 is an information modifier

Example

On February 1, a patient undergoes an iridotomy (66761) on his left eye. In the medical record, the surgeon states the patient may need a laser trabeculoplasty on the same eye. On April 10, the patient sees the doctor for a follow-up visit, and the surgeon decides to perform the second surgery the next day. The trabeculoplasty is billed as 65855-58-LT.

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