Health Information Technologies and Processes

Modifier 58

  • 1.  Modifier 58

    Posted 01-22-2020 01:08
    Hi,

    I have encountered few claims where patient returns to hospital within global period with complications, physician:  performed a procedure in bedside of the patient.
    e.g.: patient in global period of 10061 (Incision and drainage of abscess) within the global period patient returns to the physician office with infection of the procedure site. Physician performed Incision and drainage of the infected wound. Procedure performed in bedside of the patient.

    Can we code 10180 (Incision and drainage, complex, postoperative wound infection) with modifier 78 for the above scenario? However modifier 78 description says: Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period, but the current encounter procedure was performed in bedside of the patient not in operating/ procedure room. Please advise.




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    Thanks
    Aanandh S
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  • 2.  RE: Modifier 58

    Posted 01-22-2020 01:49
    HI! 
    Here's some information on how to code for post operative and/ non related post operative scenarios. It depends on the diagnosis for the post operation and the procedure in what is documented in order to properly code for these services.

    https://www.aapc.com/blog/41165-post-operative-complications-global-period/  

    --
    Sincerely,

     
    Charisse Simon, CCS/CPC
    (Certified Medical Coder/Consulting Auditor/ AHIMA ICD 10 CM/PCS Trainer)


    Skype: (415)287-0736

     
    " I have an almost complete disregard of precedent, and a faith in the possibility of something better. It irritates me to be told how things have always been done. I defy the tyranny of precedent. I go for anything new that might improve the past." - Clara Barton
     
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  • 3.  RE: Modifier 58

    Posted 01-22-2020 01:53
    Here's another CMS link that should help you in regards to CMS guidelines on Post-Op. CMS usually don't pay for Post-Op unless the patient is back in the operating room, beside procedure is not considered an OR procedure. 

     

    --
    Sincerely,

     
    Charisse Simon, CCS/CPC
    (Certified Medical Coder/Consulting Auditor/ AHIMA ICD 10 CM/PCS Trainer)


    Skype: (415)287-0736

     
    " I have an almost complete disregard of precedent, and a faith in the possibility of something better. It irritates me to be told how things have always been done. I defy the tyranny of precedent. I go for anything new that might improve the past." - Clara Barton
     
    * NOTE: This email is intended solely for the person or entity to which it is addressed and may contain confidential and/or privileged information. Any review, dissemina tion, copying, printing or other use of this email by persons or entities other than the addressee is strictly prohibited. If you receive this email in error, please contact the sender immediately and delete the material from any computer.





  • 4.  RE: Modifier 58

    Posted 01-22-2020 01:58
    Here's some more information, but I'm sure that CMS won't pay for bedside procedure that is not in the OR during the global period. Post Op procedures are using included if its related to the previous procedure, unrelated procedures would've been a whole different story as it depends on what is documented in the patient medical record. And I think this goes for insurance companies that are nonMedicare, as most insurance companies follow the CMS guidelines as well on coding procedures. CMS supercedes all state guidelines no matter what unless it a state mandatory guidelines. 






  • 5.  RE: Modifier 58

    Posted 01-22-2020 23:03
    Thank you Charisse Smith.

    The informations you provided helps to understand the modifier 58 usage.

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    Anandhan Sivagnanam
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