Appropriate use of modifier 58

Cracking the Code

Dirk Elston

Dr. Elston, who serves as director of the Ackerman Academy of Dermatopathology in New York, has served on the AMA-CPT Advisory Committee.

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I removed an atypical melanocytic lesion, but the margin was involved and I brought the patient in a week later for a re-excision of the site. Can I use modifier 58, even though the staged excision was not planned in advance?

Yes. Modifier 58 serves two major functions it indicates a planned staged excision, and can also be used when the patient requires further excision because of a positive margin.

Modifier 58 indicates a staged or related procedure or service by the same physician during the postoperative (global) period. For most excisions, the global period is 10 days. There is a zero-day global period for a biopsy or shave, and a 90-day global period if an adjacent tissue transfer was performed. (Please note that an adjacent tissue transfer already includes excision of the lesion, so the initial excision would not be reported separately. The subsequent excision would be reported).

Appropriate uses for modifier 58 include:

  • Reporting a staged procedure planned at the time of the original procedure.
  • Reporting a staged procedure that is more extensive than the original procedure.
  • Reporting definitive therapy following a diagnostic surgical procedure that included a global period (note: biopsy and shave have a zero-day global period).
  • Reporting a second or related procedure during the postoperative period. This includes re-excision for a positive margin.
Inappropriate usage:
  • Appending the modifier to services described in CPT as involving multiple sessions.
  • Reporting the treatment of a complication related to the original surgery that requires a return to the operating room.
  • Reporting an unrelated procedure during the postoperative period.

Remember that a 10-day global period begins at midnight after the procedure is performed. A 90-day global period starts at midnight the day before. When the staged or related second procedure is performed, the clock starts all over again (i.e: A new postoperative period begins at midnight after the second procedure).[pagebreak]

Examples:

Correct use of modifier 58:

A patient undergoes excision of a squamous cell carcinoma (116xx) with a discussion by the physician and the patient that after histologic examination, there may be a need to re-excise the margins should they come back positive. The histologic examination report comes back stating the margins are positive, and the physician re-excises the lesion one week after the initial surgery. The subsequent procedure was related to the first procedure, even though it was not planned in advance. As it occurred during the 10-day global period, modifier 58 should be appended.

Correct use of modifier 58:

A planned staged excision is performed for a medium-sized congenital nevus. If the second stage is performed during the 10-day global period, modifier 58 should be appended.

Incorrect use of modifier 58:

A patient undergoes excision of a basal cell carcinoma. Several days later, he has to return to the operating suite to evacuate a large hematoma. Modifier 58 is not appropriate in the case of a return to the operating room because of a surgical complication. The correct modifier is 78.

Incorrect use of modifier 58:

A patient undergoes excision of a basal cell carcinoma. Seven days later, an unrelated abscess has to be incised and drained. The second procedure occurred during the global period, but was unrelated to the initial procedure. It would be inappropriate to report the procedure with modifier 58. Instead, it should be reported with modifier 79 (unrelated surgical procedure performed during the global period).

Incorrect use of modifier 58:

A patient undergoes biopsy of a basal cell carcinoma. Several days later, he returns to have the lesion excised. A biopsy has a zero-day global period, so it would be inappropriate to append modifier 58. No modifier is needed in this situation.