Modifier 58 is a critical billing tool used to indicate a staged or related procedure performed during the post-operative period of an initial surgery. This modifier ensures that follow-up procedures, when planned or necessary for further treatment, are reimbursed appropriately.
What is Modifier 58?
Modifier 58 is used when a subsequent procedure is performed by the same provider during the post-operative period of a previous procedure. The follow-up procedure must be either:
- Planned prospectively at the time of the original procedure,
- More extensive than the initial procedure,
- Therapeutic following a diagnostic procedure.
Uses of Modifier 58
- Applied to staged or related procedures performed during the global period of an initial surgery.
- Ensures separate reimbursement for necessary follow-up procedures.
- Commonly used for reconstructive surgeries, serial debridements, and therapeutic interventions following diagnostic procedures.
Scenario: Applying Modifier 58
Scenario: A patient undergoes Mohs surgery for skin cancer removal. After the initial excision (Procedure 1), the physician performs a planned reconstructive skin graft (Procedure 2) two weeks later.
- The correct coding format: Procedure 2 CPT Code-58 (Staged procedure).
- Modifier 58 ensures that the second procedure is recognized as a necessary part of treatment and not bundled into the global period of the first.
- Without Modifier 58, the payer may deny separate reimbursement for the follow-up procedure.
Common Solutions for Correct Billing
- Document the staged nature of the procedure: Clearly state in the patient’s medical records that the follow-up procedure was planned or necessary.
- Ensure the procedure falls within the modifier’s guidelines: The subsequent procedure should be staged, more extensive, or therapeutic.
- Do not confuse Modifier 58 with Modifier 78: Use Modifier 78 only for unplanned, related procedures due to complications, not planned follow-ups.
Note:
- Modifier 58 resets the global period, meaning the follow-up procedure gets its own new post-op period.
- Should not be used for minor procedures that are part of routine post-op care.
- Incorrect use can lead to claim denials or unnecessary bundling of services.