There is often confusion over when to use Modifiers 58 and 78. The easiest way to determine the correct code is to ask yourself the following questions: “Why is the same provider doing the second procedure? Is it because the original procedure is anticipated to require more work down the road before it is fully completed?”
If the answer is yes, Modifier 58 should be used. If the answer is no, Modifier 78 – or sometimes Modifier 79 – should be used. We elaborate below.
Modifier 58 indicates that the second procedure was:
- Planned (or staged)
- More extensive than the original or the original did not achieve the desired outcome, or
- For therapy following the surgery
This modifier will restart the global period for the subsequent procedure and can be performed anywhere. The provider will receive 100% of the allowable reimbursement for both surgeries.
Modifier 78, on the other hand, is defined as “an unplanned return to the operating/procedure room by the same provider during the post-operative period.” It indicates that care was provided for a side effect of the original surgery, not the original condition. The pre- and post-operative services are included in the original surgery, this modifier cannot be performed anywhere but in the O.R. or the endoscopy suite, and reimbursement is 70-80% of the allowable fee.
This brings us to Modifier 79, which is used when an “unrelated procedure or service is performed by the same provider in a post-operative period.” The statement can be taken literally. This service has nothing to do with the original surgery, it can be performed anywhere, and it’s paid at 100% of the allowable fee.
Still unsure about which Modifier to use or have another coding question? Our team is here to help. Contact Laura Summy at email@example.com to start the conversation.
Laura Summy is Managing of coding of MMG Healthcare Solutions / Medic Management Group. MMG is a national provider of consulting services and back office administrative support to independent and system owned physician practice groups. Additionally, MMG has been formally recognized as a multi-year Northeast Ohio Top Workplaces award winner.