Post-operative period billing - Tips for use of Modifier 58 and Modifier 78
Here are tips to help physicians and coders chose the correct modifier when billing other procedures furnished during the post-operative period of a surgical procedure.
Modifier – 58 (staged or related procedure by the same physician during the post-operative period) facilitates billing of staged (planned) or related surgical procedures performed during the post-op period of the first procedure. Modifier 58 tells the payer that the procedure or service during the post-op period was:
- Planned in advance or at the time of the original procedure
- More extensive than the original procedure
- Therapy following a diagnostic surgical procedure
Modifier 58 may be reported with the planned procedure’s CPT. The new post-operative period begins when the next procedure in the series begins.
Modifier 78 (unplanned return to the operating or procedure room by the same physician following the initial procedure for a related procedure during the post-operative period) is used to indicate that a subsequent procedure that is related to the first procedure was performed during the post-op period of the initial procedure. The related procedure may be reported with the modifier 78 which tells the payer:
- A related procedure was performed in the OR/procedure room on the same day as or within the post-op period of the initial surgery
- Complications resulted from the original surgery
- The procedure code used to describe a service for treatment of complications is the same as the procedure code used in the original procedure
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