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58 modifier

Nancy Posted Thu 08th of April, 2010 14:57:48 PM

If an initial procedure is billed and has a 90 day global and at the time of the procedure it is planned to have the patient return for additional staged procedures and the CPT code is billed with a 58 modifier Is this just for informational purposes or will there be a reimbursement for this staged procedure?

SuperCoder Answered Fri 09th of April, 2010 06:25:04 AM

Yes you can bill a CPT code with a 58 modifier for this additional staged procedures.
For eg. A surgeon performs an excisional breast biopsy (19120) to examine an abnormal lump in the patient’s right breast.
The pathology report returns several days later and indicates the presence of a malignant tumor. To remove the cancerous tissue, the surgeon decides to perform a modified radical mastectomy (19307). The mastectomy occurs during the biopsy’s 90-day global period.
Reason:Because the results of the first excision led to the decision to perform the partial mastectomy, you should report both procedures separately, according to CMS guidelines outlined in the Correct Coding Initiative (CCI) and elsewhere.
In this case, you should bill for the biopsy as normal, using 19120. Because the biopsy determined the need for the mastectomy -- and because the mastectomy occurred during the biopsy’s global period -- you should append modifier 58 to the mastectomy code (19307).

SuperCoder Answered Tue 11th of May, 2010 16:41:45 PM

To answer your question, the 58 is not for just information, it is for payment, it breaks the global period and gets you paid. Meaning if a staged procedure is done outside the 90 day global, the 58 modifier should not be used, it is not needed to break the global period, which is it's purpose.

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