Is your facility still confounded about which post-surgical modifier to use on claims, regardless of the fact that the new revisions in ICD-10 are already implemented? Is your facility failing short of receiving the full reimbursement on all the procedures given? If yes, then it's time for you to introspect your billing department, and make use for specialty medical billers and coders to take of the charging prerequisites.

Below are some tips that will guarantee you're coding each post-surgical procedure effectively.

Tip 1: Don't Rely on Planning, but preparation

This year, CPT prompted that you may append modifier 58 to organized or related methods that were arranged or expected at the time of the first surgery, not only ones that your specialist arranged ahead of time.

Code Alert: The new depiction doesn't imply that you must consequently apply modifier 58 to all anticipated secondary procedures and attach modifier 78 for unplanned post-surgical methodology.

How to Code: You ought to apply modifier 58 when a procedure or administration during the post-surgery period is:

  • Arranged tentatively at the time of the first surgery, or
  • More extensive than the first procedure, or
  • Represents a surgical treatment taken after a diagnostic procedure.

Pro Tip: The patient's condition, rather than the results of a preceding surgery, diktats the need for additional procedures. You should not use modifier 58, if the patient needs a follow-up procedure to correct surgical complications that arise from the initial surgery.

Tip 2: Look out for other requirements

Keep in mind that the Urologist does not need to return the patient to the operating room (OR) for you to use modifier 58. The physician shall provide a post-operative procedure or service, for example, in his office or other outpatient facility. In most of cases however, the same Urologist must provide both the preliminary service/procedure and the follow-up procedure that requires modifier 58. Then again, if you fall short of following these new regulations, using the services of expert Urology Medical Billing and Coding agency is a sustainable option in the long run.

Tip 3: More Extensive Doesn't Always means More Complex

Try not to be confounded by the term more extensive: An extensive procedure to which you attach modifier 58 doesn't need to be more extensive or time-concentrated than the initial procedure (despite the fact that it can be). Or maybe, the urologist's consequent procedure requires just being more extensive than the work he performed within the underlying procedures. Here once more, nonetheless, the patient's condition not confusions from the initial surgery must drive the choice to perform an extra procedure.

Point to remember: More extensive is an important set of words. The context of the statement is when a patient first has a simple-type procedure and that doesn't fix the problem, so they take the patient back for a more complex-type procedure.

Clarification: Modifier 58's descriptor indicates to when the patient experiences a procedure that fails to correct the problem, which the patient has and after that the patient requires a more extensive procedure amid main procedure. A good example for this would be an extracorporeal shock wave lithotripsy (50590) which does not completely fragment a renal pelvic calculus, followed by a more invasive procedure, like a percutaneous nephrostolithotomy (50081), to completely fragment and remove the stone. The proper coding would be 50590 and 50081-58. (Though you can still refer the latest ICD-10 updates).

Pro Tip: In case you're utilizing modifier 58 because of 'more extensive' reasons, ensure that your urologist has unmistakably archived the reasons in the extra procedural codes notes. 

As an Urologist, it is your duty to get the latest codes and modifiers verified from your billing department. If they fail to do so, you always have the option of offshore Urology medical billing agencies at your service.

Published By - Medical Billers and Coders
Published Date - Jun-28-2017 Back

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