Health Information Management

Q/A: Understand proper use of modifier-58

APCs Insider, September 9, 2011

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Q: A patient underwent an excision of large infected mass in our hospital outpatient surgery department a week ago. The physician did not perform a repair at the time of excision. The physician stated in documentation that the wound would be left open to drain and further stated plans to repair the wound ona different date of service. The patient now presents for repair of the surgical wound. Because this was a staged procedure, should we append modifier -58 (staged or related procedure or service by the same physician during the postoperative period)?

A: The code description indicates that coders should append modifier -58 only when a staged or related procedure is performed by the same physician during the postoperative period. Unlike physician professional billing, which has a global time period of 10–90 days, hospital outpatient procedures do not have a global time period. Instead, the time frame for a hospital’s postoperative period is the same calendar day as the initial surgery.

Therefore, do not append modifier -58 on the facility claim because the first and second procedures were performed on different calendar days.

Editor’s note: Andrea Clark, RHIA, CCS, CPCH, president of Health Revenue Assurance Associates, Inc., in Plantation, FL, answered this question.



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