Keeping Compliant With Modifier Use

The Coding Institute LLC, 2222 Sedwick Road, Durham, NC 27713, Eenterprise Contact: Sam Nair, Direct: 704 303 8150,

[email protected]

Keeping Compliant With Modifier Use By Susan Dooley

Here’s one of the truths of medical coding: Modifiers matter. Coders use modifiers to change, or modify,

a code’s official description without changing its core meaning.

Modifiers also give the payer more information about the service provided to the patient, saidBarbara J.

Cobuzzi, MBA, CPC, CENTC, COC, CPC-P, CPC-I, CPCO, in her AudioEducator webinar presentation,

“Modifier Knowledge: Learn to Compliantly Append and How Modifiers Affect Payments.”

“Remember, most of the time the payer doesn’t get the documentation; usually they just get the CMS

1500 claim form electronically,” Cobuzzi said. The payer doesn’t know what happened during the office

visit or in the operating room other than what you tell them with the five-digit CPT® code and the ICD-

10-CM diagnosis code, she explained. “Sometimes we need to give more information, and that modifier

lets us do that, telling the story of how this case is different from other cases,” Cobuzzi added.

A little later we’ll tell you how you can glean Cobuzzi’s modifier wisdom by attending her AudioEducator

webinar, so stay tuned.

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Review the Details: Reporting Modifier 58

According to CMS guidelines, you use modifier 58 when a second surgery is performed during the

postoperative period of another surgery when the procedure that follows the original one was planned

or “staged,” more extensive than the original procedure, performed for therapy after a surgical

procedure, or for reapplication of a cast during the 90-day global period.

Here’s an example where you might use modifier 58. A colorectal surgeon does a diagnostic

sigmoidoscopy. Based on the findings discovered during the diagnostic sigmoidoscopy, she decides the

situation is so urgent that the patient’s condition requires immediate colectomy. You would report the

following on your claim:

45330, Sigmoidoscopy, flexible; diagnostic, with or without collection of specimen(s) by brushing

or washing (separate procedure)

44140, Colectomy, partial; with anastomosis.

In this scenario, you would append modifier 58 to 44140 to alert the payer that the colectomy is the

more extensive service, performed after the diagnostic procedure. More extensive just means a

procedure in which the surgeon went beyond the work performed in the initial procedure. One thing to

notice about this particular scenario is that the sigmoidoscopy (45330) has 0 global days, so if an

operating room wasn’t available to perform the colectomy that same day, you wouldn’t need to append

modifier 58 to 44140.

What About You?

Sometimes it seems like there’s a modifier for every occasion. Is there a particular modifier that you

have trouble with? Let us know.

Learn to Compliantly Append Modifiers With AudioEducator

Correct modifier use means money — and compliance, too. Proficiency with modifier use is key for

coders, billers, and physicians to ensure compliance and accuracy. Let expert speaker Barbara J. Cobuzzi

help you understand E/M, global, and bundling modifiers and how they affect coding and payment.

You’ll learn what documentation is needed to support each modifier, gain insight on the concept of

global packaging, and review modifiers for postop followup care, operating room procedures, and CCI or

bundling modifiers. There’s so much more packed into this 90-minute prerecorded AudioEducator

presentation. Register today and learn at your leisure. Contact us!





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Contact Us:

Name: Sam Nair

Title: Associate Director Enterprise Practice

Email: [email protected]

Direct: 704 303 8150

Desk: 866 228 9252, Ext: 4813

The Coding Institute LLC, 2222 Sedwick Road, Durham, NC 27713



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Keeping Compliant With Modifier Use