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Coding tip: Understand the use of modifier -58 in your ASC

Ambulatory Surgery Reimbursement Update, August 28, 2007

What does modifier -58 mean for your ASC facility? It means that your physician may need to indicate on the operative report the procedure that he or she performed during the postoperative (or "global") period was either planned at the time of the original procedure or was more extensive than the original procedure.

Coders use modifier -58 to report a staged or related procedure by the same physician during the postoperative period of the first procedure. Coders do not use modifier -58 to report treatment of a problem that requires a return to the operating room.

A new postoperative period for the ASC begins when a provider bills the next procedure. When a physician performs a staged procedure in an ASC, it is not necessary for the coder to append modifier -58, unless it occurs during the facility's global period, which is 24 hours for an ASC.

If the patient returns to the operating room within that 24-hour period, then the coder should append modifier -58. Otherwise, bill the procedure code alone, regardless of the fact that the coder may need to append modifier -58 on the claim, because the physician's global period for the staged procedure is 90 days.

This tip is brought to you by Ellis Medical Consulting, Inc.