Practice Management and Prior Authorization for Interventional Pain and Orthopedic Spine Surgery. Patients Access and Healthcare Financial Management Consulting Company | GoHealthcare Practice Solutions
  • About
  • Services
    • Prior Authorization Services
    • Patient Access Services
    • Medical Scribe Services
    • Coding and Documentation Audit Review
    • ​E/M & Surgical Coding Education and Training
    • RCM FULL SERVICES
  • READ OUR BLOG
  • Let's Meet in Person
    • 2023 ORTHOPEDIC VALUE BASED CARE CONFERENCE
    • 2023 AAOS Annual Meeting of the American Academy of Orthopaedic Surgeons
    • 2023 ASIPP 25th Annual Meeting of the American Society of Interventional Pain Management
    • 2023 Becker's 20th Annual Spine, Orthopedic & Pain Management-Driven ASC Conference
    • 2023 FSIPP Annual Conference by FSIPP FSPMR Florida Society Of Interventional Pain Physicians
    • 2023 New York and New Jersey Pain Medicine Symposium
  • Testimonials
  • Frequently Asked Questions and Answers - GoHealthcare Practice Solutions
  • FREE ASSESSMENT
  • Readers Questions

Blog Posts

Understanding how to use modifier 58

9/1/2018

0 Comments

 
​Modifier 58  Staged or Related Procedure or Service During Postoperative Period by Same Physician
Picture


​Guideline:

The same physician planned, at time of original surgery/procedure, a return trip to operating or procedure room within 10 or 90 day post op days



​

WHEN IT IS APPROPRIATE:
  • Treatment of problem requiring a return to operating/procedure room
  • More extensive than original procedure
  • Unanticipated clinical condition
  • Therapy following a diagnostic, surgical procedure                                
  • Each case requires surgical documentation and evaluation
Modifier 58 appropriate for example; hardware removal was planned as part of therapeutic approach involving multiple, staged procedures to the surgical intervention

Physicians in same specialty, same group are to bill and are reimbursed as a single physician

Key to Remember!  Use modifier 78 (not 58!) for treatment problems unplanned requiring return trip to operating room

If hardware removed in unplanned surgery return for a complication, (e.g. infection of the wound site or rejection of the hardware itself), modifier 78 appropriate

It is NOT APPROPRIATE WHEN:
  • Not appropriate for E/M - Evaluation and Management! or assistant surgery services

References:
CMS Medicare Website
Coding Books
​Payers Websites
0 Comments

Your comment will be posted after it is approved.


Leave a Reply.

    Picture
    ABOUT THE AUTHOR:
    Ms. Pinky Maniri-Pescasio is the Founder of GoHealthcare Consulting. She is a National Speaker on Practice Reimbursement and a Physician Advocate. She has served the Medical Practice Industry for more than 25 years as a Professional Medical Practice Consultant.

    View my Profile on Linkedin
    View my profile on LinkedIn
    READERS QUESTIONS
    Picture
    Ad: Immune Shield is the breakthrough new, doctor-approved supplement for quickly strengthening and protecting your immune system. Check it out!
    Picture
    Ad: Make Dinner in 15 Minutes

    search here

    Medical Billing and Coding Webinars
    Learn from the EXPERTS in the Industry

    RSS Feed

    Archives

    March 2023
    February 2023
    January 2023
    November 2022
    September 2022
    July 2022
    June 2022
    May 2022
    April 2022
    March 2022
    February 2022
    October 2021
    July 2021
    June 2021
    February 2021
    January 2021
    October 2020
    September 2020
    August 2020
    July 2020
    June 2020
    April 2020
    March 2020
    December 2019
    February 2019
    September 2018
    August 2018
    February 2018
    January 2018
    December 2017
    September 2017
    August 2017
    June 2017
    May 2017
    February 2017
    October 2016


    Categories

    All
    10 Common Reasons Claims Gets Denied And Reject
    2019 New CPT Codes Medicare Payments For Virtual Services Remote Monitoring Interprofessional Consultation
    Chronic Care Management In 2017 Changes
    Events
    Medical Modifiers
    Pain Management Billing
    Pain Management Billing Codes
    Practice Management
    READER'S QUESTION
    Revenue Cycle
    Spinal Fusion Billing And Coding
    When To Use Medicare's ABN Advanced Beneficiary Notice Claim Reporting Modifiers
    You Be The Biller
    Your Be The Coder

    RSS Feed


    BROWSE HERE

    All
    10 Common Reasons Claims Gets Denied And Reject
    2019 New CPT Codes Medicare Payments For Virtual Services Remote Monitoring Interprofessional Consultation
    Chronic Care Management In 2017 Changes
    Events
    Medical Modifiers
    Pain Management Billing
    Pain Management Billing Codes
    Practice Management
    READER'S QUESTION
    Revenue Cycle
    Spinal Fusion Billing And Coding
    When To Use Medicare's ABN Advanced Beneficiary Notice Claim Reporting Modifiers
    You Be The Biller
    Your Be The Coder


© COPYRIGHT 2019 GoHealthcare Consulting and Business Development LLC. ALL RIGHTS RESERVED.
  • About
  • Services
    • Prior Authorization Services
    • Patient Access Services
    • Medical Scribe Services
    • Coding and Documentation Audit Review
    • ​E/M & Surgical Coding Education and Training
    • RCM FULL SERVICES
  • READ OUR BLOG
  • Let's Meet in Person
    • 2023 ORTHOPEDIC VALUE BASED CARE CONFERENCE
    • 2023 AAOS Annual Meeting of the American Academy of Orthopaedic Surgeons
    • 2023 ASIPP 25th Annual Meeting of the American Society of Interventional Pain Management
    • 2023 Becker's 20th Annual Spine, Orthopedic & Pain Management-Driven ASC Conference
    • 2023 FSIPP Annual Conference by FSIPP FSPMR Florida Society Of Interventional Pain Physicians
    • 2023 New York and New Jersey Pain Medicine Symposium
  • Testimonials
  • Frequently Asked Questions and Answers - GoHealthcare Practice Solutions
  • FREE ASSESSMENT
  • Readers Questions