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

For more details on Global Surgery refer to the link.