Quick Answer: What Is A 58 Modifier?

What is a 54 modifier used for?

Surgical Care Only.

When a physician or other qualified health care professional performs a surgical procedure and another provides preoperative and/or postoperative management, surgical services may be identified by adding this modifier to the usual procedure code..

Does modifier 58 reduce payment?

Modifier -58 should not alter the amount charged or paid for subsequent unrelated or staged procedures that are performed during the postoperative period of a previous procedure. Modifier -78 may drive a reduction because it is for management of a complication resulting from the previous procedure.

What is the difference between modifier 58 and 78?

Modifier 58 and modifier 78 are often mixed up, because both refer to related procedures by the same physician in the post-operative period. However, modifier 58 generally describes staged/planned procedures, while modifier 78 is used for unexpected procedures.

How does modifier 57 affect payment?

By appending modifier 57 to an E/M code, you are alerting the payer that the E/M service—on either the day of, or the day before, a major surgical procedure—was the service at which the physician determined the surgery was appropriate and medically necessary, and is therefore not bundled to the surgery payment.

What is modifier 55 used for?

Postoperative Management Only. When a physician or other qualified health care professional performs the postoperative management and another physician performed the surgical procedure, the postoperative component may be identified by appending this modifier to the surgical procedure.

Does modifier 58 Start a new global period?

Modifier –58 reimburses the surgeon based on 100 percent of the allowed amount and restarts the global period (as long as it exceeds the first global period).

What is a 58 modifier used for?

Staged or related procedure or service by the same physician during the postoperative period. 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);

What is a 59 modifier?

Modifier 59 is used to identify procedures/services, other than E/M services, that are not normally reported together, but are appropriate under the circumstances. … Only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used.

What does Xe modifier mean?

Separate EncounterModifier Definition Modifier XE Separate Encounter, A Service That Is Distinct Because It Occurred During A. Separate Encounter. Modifier XS Separate Structure, A Service That Is Distinct Because It Was Performed On A. Separate Organ/Structure.

What is a 51 modifier?

Modifier 51 Multiple Procedures indicates that multiple procedures were performed at the. same session. It applies to: • Different procedures performed at the same session. • A single procedure performed multiple times at different sites.

Can you bill modifier 58 and 59 together?

Modifier -59 (distinct procedural service) should always be the modifier of last resort. … For hospital outpatient billing, coders and billers should only use modifier -58 on the same date as the original procedure. The modifier becomes unnecessary later.

Which CPT code does modifier 59 go on?

If the circumstance calls for a Level 3 established patient visit (CPT code 99213) to be billed with psychological testing (such as CPT code 96101), modifier 59 would be appended to the testing code.

What is the 26 modifier?

The CPT modifier 26 is used to indicate the professional component of the service being billed was “interpretation only,” and it is most commonly submitted with diagnostic tests, including radiological procedures. When using the 26 modifier, you must enter it in the first modifier field on your claim.

Can modifier 58 and 79 be used together?

Modifiers 58, 78, and 79 are all used in conjunction with procedures performed within the global period of another procedure.

What is modifier 76 used for?

Modifier 76 is used to report a repeat procedure or service by the same physician and is appended to the procedure to report: Repeat procedures performed on the same day. Indicate that a procedure or service was repeated subsequent to the original procedure or service.

Can modifier 58 be used in the office?

We typically look to modifier 58 to indicate an expected return to the operating room to complete a procedure in stages. By contrast, we look to modifier 78 if the return to the operating room is unplanned. But an unplanned return to the procedure room may still call for modifier 58.

What is modifier 57 used for?

Modifier 57 Decision for Surgery: add Modifier 57 to the appropriate level of E/M service provided on the day before or day of surgery, in which the initial decision is made to perform major surgery. Major surgery includes all surgical procedures assigned a 90-day global surgery period.

What is a 56 modifier?

Modifier 56 indicates that a physician or qualified health care professional other than the surgeon performed the preoperative care and evaluation prior to surgery.