Modifier 58 Versus 78 – Which Should You Use?



Ever get confused between modifiers 58 and 78? You're not alone! Many medical coders struggle to tell them apart. But fear not, this breakdown will clear things up.

The Big Picture:

  • Modifier 58: Same underlying condition, additional procedure (planned or unplanned).
  • Modifier 78: New problem caused by the surgery (complication) requiring a return to the OR.

Understanding Modifier 58: Staged or Related Procedure

Use this modifier for additional procedures during recovery, even if unplanned, as long as they address the original issue.

Key Point: Modifier 58 indicates a procedure related to the first surgery, but it can be planned ahead of time or arise unexpectedly.

Planned Staged/Related Procedures:

These are common after major surgeries where waiting for the recovery period to end isn't ideal. Surgeons can use modifier 58 for each stage within this initial period, allowing separate payment for each procedure. Each stage usually restarts the recovery clock.

Example:

  • A patient undergoes a pharyngectomy (throat removal) followed by pharyngoplasty (throat reconstruction) 10 days later. Modifier 58 is added to the pharyngoplasty code to show it's a planned, staged procedure.

Read more: https://www.allzonems.com/modifier-58-versus-78-which-should-you-use/

5 Ways Medical Coding Services Empower Physicians

1. Expertise at Your Fingertips: Medical coding is intricate, demanding in-depth knowledge of medical terms, procedures, and coding rules. Partnering with a medical coding service puts certified coders at your disposal. They translate medical records into accurate codes, minimizing errors and reducing claim denials or audits.

2. Time Saved, Resources Freed: Coding can be a time drain for physicians and staff. Outsourcing it allows you to focus on patient care, not paperwork. You also save on hiring, training coders, and maintaining coding software.

3. Stay Compliant, Stay Ahead: Healthcare regulations and coding guidelines are constantly changing. Medical coding services stay current on these changes, ensuring your practice adheres to them, minimizing legal risks and penalties.

4. Boost Your Revenue Cycle: Accurate and timely coding is crucial for optimizing your practice's revenue cycle. Proper coding ensures claims are processed quickly and accurately, leading to faster reimbursements and improved cash flow. Medical coding services can streamline your billing process, reduce denials, and maximize revenue by identifying missed opportunities.

5. Focus on What Matters Most: By outsourcing medica coding company, you can focus on your core strengths: providing exceptional patient care, growing your practice, or continuing your education. Delegating coding allows you to work more efficiently and effectively, ultimately improving patient care.

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