Modifier 58 is described in the CPT Manual as follows: “staged or related procedure or service by the same physician during the postoperative period”.
Usage Of The 58 Modifier
The 58 modifier may be used to indicate that a procedure was followed by a second procedure during the postoperative period of the first procedure.
This situation may occur because the second procedure was planned prospectively, more extensive than the first, or therapy after a diagnostic surgical service. Modifier 58 will bypass NCCI edits that allow the use of NCCI-associated modifiers.
Inappropriate Usage of Modifier 58
Modifier 58 needs to be reported correctly. The following situations are inappropriate.
- Appending modifier 58 to ASC facility fee claims
- Appending the 58 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 the retina, one or more sessions)
- Reporting the treatment of a complication from the original surgery
- Unrelated procedures during the postoperative period
Do not use this modifier to report the treatment of a problem that requires a return to the operating room (see Modifier 78).
CPT Modifier 58 does not negate the global fee concept; therefore, services 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 performed during the postoperative period of a previous procedure. Modifier 78 may drive a reduction because it is for the management of a complication resulting from the previous procedure.
Indicating The Procedure Or Service
When reporting Modifier 58, the physician may need to indicate that the procedure or service was:
- Planned prospectively at the time of the original procedure, or staged.
- More extensive than the original planned procedure.
- For therapy following a diagnostic surgical procedure.
Billing Example 1
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 the 58 modifier 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.