What is a 58 modifier used for?

Submit CPT modifier 58 to indicate that the performance of a procedure or service during the postoperative period was either: Planned prospectively at the time of the original procedure (staged); More extensive than the original procedure; or. For the therapy following a surgical procedure.

What is a 58 modifier in medical billing?

staged or related procedure
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.

How does modifier 58 affect reimbursement?

Modifier 58: to indicate a second procedure was performed as a staged procedure. Reimbursement should be 100% of the allowable fee. Modifier 79: To indicate an unrelated procedure was performed during the global period of the original procedure. Reimbursement should be 100% of the allowable fee.

Can 92014 and 92134 be billed together?

Can 92133 and 92134 be used on the same visit? A. No, they cannot be billed at the same patient encounter, per CPT instructions.

When can you use modifier 58?

Modifier 58 is used for a “staged or related procedure or service by the same physician during the post-operative period.” Further, according to CMS.gov, modifier 58 indicates that the procedure was: Planned, either at the time of the first procedure or prospectively.

Does modifier 58 go on add on codes?

Each add-on code relates back to the primary code, so if the primary code has -58, then they add-on codes don’t need it.

How do modifiers affect reimbursement?

In some cases, addition of a modifier may directly affect payment. Placement of a modifier after a CPT or HCPCS code does not insure reimbursement. Medical documentation may be requested to support the use of the assigned modifier.

How does modifier 59 affect reimbursement?

The 59 modifier allows for reduction because each procedure contains the reimbursement for the prep as well as the procedure. The 59 says this procedure is performed in the same session, there for the prep is then carved out of the reimbursement or as we say discounted.

Does CPT 92134 need a modifier?

Use CPT code(s) 92133 or 92134 to report OCT, include any necessary modifiers (e.g. 26, TC).

What is procedure code 92134?

92134. SCANNING COMPUTERIZED OPHTHALMIC DIAGNOSTIC IMAGING, POSTERIOR SEGMENT, WITH INTERPRETATION AND REPORT, UNILATERAL OR BILATERAL; RETINA.

Can modifier 58 be used in the office?

When the patient presents in the office for stent removal, a 52310 Cystourethroscopy, with removal of ureteral stent with modifier 58 can be billed out.” In this case, the “follow up” procedure is both planned prospectively and more extensive to the original procedure.

Can modifier 58 be used in an office setting?

The subsequent procedure is done because of a complication from the initial procedure. The subsequent procedure is not for a complication. Modifier 78 requires a return to the operating room or endoscopy suite. Modifier 58 does not require a return to the operating room.