Taking the CPC exam? Brush up your modifier 58 know-how

Published: 18th February 2010
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Choosing the right modifier to describe a scenario is a tricky affair. If you're taking the CPC exam, you should have a thorough knowledge about modifiers. In fact your modifier know-how can make or break your performance on the exam. To have a better idea about modifiers, you can go for the 2010 CPC exam review.


In this article, we'll bring you the lowdown on modifier 58 (staged or related procedure or service by the same physician during the postoperative period).


In order to apply modifier 58 appropriately, it's important that the physician planned a supplementary service - during the global period of another procedure - or that the patient required the supplementary service to complete treatment begun at an earlier date.


CPT lays down that you may consider modifier 58 for a procedure or service during the postoperative period if the procedure or service is planned or anticipated at the time of the original procedure, more expensive than the original procedure or for therapy following a diagnostic surgical procedure.


In each case, the subsequent procedure or service is either related to the underlying problem/diagnosis that prompted the initial surgery or anticipated at the time the surgeon performs the initial surgery (or both) according to CPT instructions.


In one sample CPC question, the correct answer hinged on the test taker's ability to choose correctly between modifier 58 and modifier 78.


You should not use modifier 58 if the patient needs a follow-up procedure because of surgical complications or unexpected postoperative findings that arise from the initial surgery. The follow-up procedure should come up because of the same condition that prompted the initial procedure. Meaning, you should not use modifier 58 to describe treatment for a complication - that is, for a different condition that arises as a consequence of or following an initial procedure.


Therefore, a complication may be related to the initial procedure, but it's not related to the patient's initial condition. For complications that call for a return to the operating room, you should instead go for modifier 78 to the follow-up procedure.


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