modifier 58 definition

Modifier 58 – Usage and Reimbursement

The Modifier 58 definition is explained as the CPT Manual as a “staged or related procedure or service by the same physician during the postoperative period”.  It may be used to indicate that a procedure was followed by a second procedure during the post-operative period of the first procedure. This situation may occur because the second procedure was planned prospectively, was more extensive than the first procedure, or was therapy after a diagnostic surgical service. Use of modifier 58 will bypass NCCI edits that allow use of NCCI-associated modifiers.

Examples for the Usage of Modifier 58

58 Modifier examples: If a diagnostic endoscopic procedure results in the decision to perform an open procedure, both procedures may be reported with modifier 58 appended to the HCPCS/CPT code for the open procedure.  However, if the endoscopic procedure preceding an open procedure is a “scout” procedure to assess anatomic landmarks and/or extent of disease, it is not separately reportable.

Another example of when to use modifier 58 would be if a patient had a removal of a breast lesion (CPT 19120) followed in less than 90 days by the removal of the entire breast (CPT 19307). Bill CPT 19307-58 for the second procedure. Another postoperative period begins when the second procedure in the series is billed.

Inappropriate Usage

Appending the modifier to ASC facility fee claims

Appending the modifier to a procedure with XXX global period on the MPFSDB

Appending the modifier to services listed in CPT as multiple sessions, (i.e. 67208, Destruction of localized lesion of retina, one or more sessions)

Reporting the treatment of a complication from the original surgery

Unrelated procedures during the postoperative period

When reporting Modifier 58, the physician may need to indicate that the procedure or service was:

1. Planned prospectively at the time of the original procedure, or staged.

2. More extensive than the original planned procedure.

3. For therapy following a diagnostic surgical procedure.

Do not use this modifier to report the treatment of a problem that requires a return to the operating room (see Modifier 78).

The existence of CPT Modifier 58 does not negate the global fee concept; therefore, services that are included in CPT as multiple sessions or are otherwise defined as including multiple services or events may not be billed with this modifier.

Modifier -58 should not alter the amount charged or paid for subsequent unrelated or staged procedures that are performed during the postoperative period of a previous procedure. Modifier -78 may drive a reduction because it is for management of a complication resulting from the previous procedure.

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