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Modifiers 58 & 79

Tammy Posted Fri 14th of November, 2014 15:46:11 PM

I am so confused, because my provider is wanting to bill the PRP (67228) on the RT eye after a focal laser (67210) she did 3 weeks prior on the RT eye. She is telling me its staged but is still wanting to bill the 79 modifier with the 58 modifier. I didn't think you could bill these 2 modifiers together. Is there a reference book just on proper usage of modifiers for Ophthalmology? Sometimes these modifiers get confusing, so any advice on this would be greatly appreciated. Thank you!

SuperCoder Answered Fri 14th of November, 2014 17:14:24 PM

58 modifier is used when the procedure being done in the post operative period of the first procedure. It is planned to be performed at a later date. A procedure that is staged would be related to the first procedure done. Therefore you should never use 58 and 79 togethr.

79 modifier is used for an unrelated procedure in the post operative period of the first procedure.

You may also want to look at modifier 78 for a return to the operating/procedure room for a related procedure.

For additional information regarding the use of the modifiers please see the following articles.

https://www.supercoder.com/coding-newsletters/my-modifier-coding-alert/compliance-eliminate-3-modifier-mishaps-that-could-be-costing-your-practice-money-140342-article

https://www.supercoder.com/coding-newsletters/my-medicare-compliance-reimbursement-alert/modifiers-clear-up-modifier-79-confusion-122192-article

https://www.supercoder.com/coding-newsletters/my-ophthalmology-coding-alert/document-unrelated-for-modifier-79-services-98049-article

Hope this helps.

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