Why is 58 modifier used?
Asked by: Miss Glenda Leannon Jr. | Last update: April 3, 2025Score: 4.6/5 (42 votes)
When should modifier 58 be used?
Modifier 58 is defined as a staged or related procedure performed during the postoperative period of the first procedure by the same physician. A new postoperative period begins when the staged procedure is billed.
What is the difference between 58 and 59 modifiers?
Commonly used modifiers to communicate these unique circumstances include Modifier 58 (staged procedure within the global period), Modifier 59 (distinct procedural service), Modifier 76 (repeat procedure), Modifier 78 (subsequent or related procedure/ service within a global, unplanned return to the operating room), ...
What is an example of a staged or related procedure?
An example of a planned staged or related surgery is a patient who had a pharyngectomy for a malignant neoplasm of the pharynx. The surgeon then brought the patient back into the OR 10 days later to reconstruct the pharynx. Modifier 58 is added to pharyngoplasty to indicate that this was a staged procedure.
Why do we use modifier 57?
Modifier 57 should be appended to any E/M service on the day of or the day before said procedure when the E/M service results in the decision to go to surgery. This informs the payer that the physician determined the surgery was medically necessary. Modifier 57 should only be appended to E/M codes.
When To Use A Modifier in Medical Coding
What is the 59 modifier used for?
Modifier 59 Distinct Procedural Service indicates that a procedure is separate and distinct from another procedure on the same date of service. Typically, this modifier is applied to a procedure code that is not ordinarily paid separately from the first procedure but should be paid per the specifics of the situation.
What is an inappropriate use of the 57 modifier?
Inappropriate Uses
Appending to an E/M procedure code performed the same day as a minor surgery. When the decision to perform a minor procedure is done immediately before the service, it is considered a routine preoperative service and not billable in addition to the procedure.
Which scenario qualifies for modifier 58?
In surgical situations when a subsequent procedure takes place within the global period of the original procedure, and/or because the physician anticipated a planned (or staged) procedure, modifier 58 comes into play.
What is the Medicare Code 58?
Denial code 58 is used when the payer determines that the treatment or service was provided in a location that is considered inappropriate or invalid according to their guidelines.
What is an example of staged?
staged adjective (PERFORMED/ARRANGED)
arranged in order to give people a particular impression, sometimes in order to deceive them: The romance was made public at a staged photo opportunity at a London restaurant.
Which modifier should go first?
Informational or statistical modifiers (e.g., any modifier not classified as a payment modifier) should be listed after the payment modifier. If multiple informational/statistical modifiers apply, you may list them in any order (as long as they are listed after payment modifiers).
How to tell if CPT codes are bundled?
This depends on medical coding rules. Bundling occurs when procedures or services with unique CPT or HCPCS Level II codes are billed together under one code. Unbundling is when two or more codes that are normally part of a single procedure can be billed separately.
Can CPT II codes be billed alone?
Report the appropriate CPT II code for the LDL-C result value. CPT Category II codes can be reported alone on a claim with $0.00 value (or $0.01 value if your system requires it in order for the codes to populate on a claim).
What is a staged surgical procedure?
Staging procedures is when more than one operation is recommended to achieve a result more safely, predictably, or both. The most commonly staged procedures for cosmetic plastic surgery are body contouring procedures.
How do you know if a code needs a modifier?
- The service or procedure has both professional and technical components.
- More than one provider performed the service or procedure.
- More than one location was involved.
- A service or procedure was increased or reduced in comparison to what the code typically requires.
Which CPT code is used for a complicated incision and drainage?
10060 Incision and drainage of abscess; simple of single. 10061 Incision and drainage of abscess; complicated or multiple.
When should you use modifier 58?
Modifier 58. Modifier 58 Staged or related procedure or service by the same physician during the postoperative period may be necessary to indicate the performance of a procedure during the postoperative period was: Planned prospectively at the time of the original procedure, or “staged;”
What is procedure code 58?
Lay Term. Append modifier 58 to a procedure occurring during the postoperative period when the procedure is planned or staged.
What is authorization code 58?
58 – Transaction not permitted - Terminal
This code will appear if you are attempting a transaction and your merchant processing account is not properly configured. Contact your merchant provider and make sure your terminal/POS is set up to receive the type of payment you're attempting.
Can modifier 58 and 82 be billed together?
This modifier should be removed and the service(s) resubmitted with HCPCS modifier AS or CPT modifier 80, 81 or 82. It is generally not appropriate to submit CPT modifier 58 with these CPT codes.
What modifier is used for multiple procedures?
Modifier 51 is defined as multiple surgeries/procedures. Multiple surgeries performed on the same day, during the same surgical session.
What is modifier 59 used for?
For the NCCI, the primary purpose of CPT® modifier 59 is to indicate that two or more procedures are performed at different anatomic sites or during different patient encounters. It should only be used if no other modifier more appropriately describes the relationships of the two or more procedure codes.
What is the difference between 58 and 79 modifier?
Modifiers 58 and 78 are always for procedures related to another procedure. With modifier 79, it doesn't matter whether the procedure was planned or unplanned during the previous procedure, because there's no connection between the different operations.
What is an unnecessary modifier?
A modifier is a word or a group of words which describe, limit, or qualify a subject. There are two kinds of modifiers: nonrestrictive and restrictive. Nonrestrictive modifiers are not essential or not necessary to the meaning of a sentence while restrictive modifiers are necessary to the meaning of the sentence.
Why use modifier 52?
Modifier -52 is used to indicate partial reduction or discontinuation of radiology procedures and other services that do not require anesthesia. The modifier provides a means for reporting reduced services without disturbing the identification of the basic service.