Lori Posted Fri 07th of September, 2012 15:20:13 PM
We have a question regarding which modifier to use for the CPT code
10060. The patient had an I & D then came in 6 days later for her well visit, which we had to perform another I & D due to the condition of her abscess. We billed a modifier "25" with a procedure code
99392 with the V20.2 ICD-9 code and a procedure code
10060without a modifier and with ICD-9 code 682.5. We were denied payment on both codes and we were told that an extra modifier was required. We rebilled with a modifier "59" to procedure code
10060 along with procedure code
99392 with a modifier "25". They denied again. Would there be another modifier that our pediatricians could use for
10060? We appreciate any feedback regarding this matter.
SuperCoder Answered Fri 07th of September, 2012 19:41:28 PM
Since the Global Period of 10060 is 10 days , use Modifier 78 with 10060.
Lori Posted Fri 26th of October, 2012 19:42:44 PM
We wanted to revisit this question regarding modifier "78". We are pediatricians and reading the description for this modifier, it sound like something that surgeons would use. We are not surgeons. Could we still use this modifier even if we are not surgeons?
SuperCoder Answered Mon 29th of October, 2012 16:43:05 PM
Good Question.Modifier 78 may not be used with place of service 11 (office). Modifier 78 requires a return to the operating room or procedure room (e.g. Cath Lab, Interventional Radiology Procedure
Room, Endoscopy Room).
You can use Modifier 58 for this case.Staged or Related Procedure or Service by the Same Physician During the Postoperative Period.
10060 has a global period of 10 days and the patient returned only after 6 days.
Lori Posted Thu 01st of November, 2012 14:41:33 PM
Thank you for your reply.
Modifier 58 can be used with place of service 11 (office). Is that correct?
SuperCoder Answered Thu 01st of November, 2012 20:10:39 PM
Yes true, Modifier 58 may be appended to surgical CPT codes in any place of service, assuming that the second or subsequent procedure is staged or anticipated.
SuperCoder Answered Thu 01st of November, 2012 20:13:03 PM
You should use modifier 24 on 99393. Modifier 24 is for an unrelated EM service during a postoperative period. I apologize for the above inaccurate answers.
Jen Godreau, CPC, CPMA, CPEDC