What is the difference between a 58 and 78 modifier?
Modifier 58 and modifier 78 are often mixed up, because both refer to related procedures by the same physician in the post-operative period. However, modifier 58 generally describes staged/planned procedures, while modifier 78 is used for unexpected procedures.
What is a 58 modifier used for?
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 a 78 modifier used for?
Modifier 78 is used to report an unplanned return to the operating or procedure room, by the same physician, following an initial procedure for a related procedure during the post-operative period.
How much does modifier 78 reduce payment?
Modifiers 78: To indicate that a complication of an original procedure was treated by a return to the operating room, catheterization or endoscopy suite. Reimbursement should be at 70-80% of the allowable fee.
Which modifier goes first 78 or 59?
guidelines: order of modifiers
If you have two pricing modifiers, the most common scenario is likely to involve 26 and another modifier. Always add 26 before any other modifier. If you have two payment modifiers, a common one is 51 and 59, enter 59 in the first position. If 51 and 78, enter 78 in the first position.
Does modifier 58 Start a new global period?
Modifier 58=The global period restarts with the subsequent procedure, and the surgeon should receive 100 percent of the allowable reimbursement on both the first and the subsequent procedures.
Can modifier 58 and 79 be used together?
Modifiers 58, 78, and 79 are not considered valid for procedures with a Global Days indicator setting of 000, XXX, or ZZZ. 5. Modifiers 58, 78, and 79 are mutually exclusive to one another; only one of these modifiers may apply to a service or procedure performed within a postoperative global period.
Can you use modifier 58 and 78 together?
Modifier 58 breaks the original global period and starts a new global period. Modifier 78 does not.
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Don’t Let Reimbursement Rule Your Decision.
| Modifier 78 | Modifier 58 |
|---|---|
| The subsequent procedure is unplanned. | The subsequent procedure is planned or staged or is more extensive than the initial procedure. |
When should a modifier 59 be used?
Modifier 59 should be used to distinguish a different session or patient encounter, or a different procedure or surgery, or a different anatomical site, or a separate injury. It should also be used when an intravenous (IV) protocol calls for two separate IV sites.
Can you use modifier 78 in the office?
Unlike modifiers 58 and 79, 78 may not be performed anywhere but in the O.R. or the endoscopy suite.
Does modifier 78 Start a new global period?
Modifier 78 is only appended during the global period; it does not restart the global period and, as a result, the surgeon expects a reduction in reimbursement for the subsequent procedure.
Does modifier 58 require a return to the or?
Modifier 58 does not require a return to the operating room.
When to use 59 or 51 modifier?
Modifier 51 impacts the payment amount, and modifier 59 affects whether the service will be paid at all. Modifier 59 is typically used to override National Correct Coding Initiative (NCCI) Edits.