Medical Billing Forum
Coding => Coding => : CALI April 23, 2014, 08:19:49 PM
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Hi,
I billed a 10160 with a modifier 58; it was denied for being in the post op period for billing 27048 within the 90 global period. I thought modifier 58 would be appropriate. Please advise as the doctor has the patient coming in once a week and charging for a 10160.
Thanks, I'm desperate
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Not a certified coder but let take me take a stab at this. But first question.. Surgeon is using ultrasound to rule out DVT? Yes.. No? Or is there another reason?
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Hello!
Modifier 58 is for a staged (planned) procedure performed during the post-operative period of the original procedure. Without the diagnosis codes it's hard to determine if an appeal is a possible solution as your next step.
Your original claim was filed with 27048 (Excision of tumor from hip) and the denied claim is billing for 10160 (Puncture aspiration of abscess, hematoma, bulla or cyst). Was this procedure actually related to the original surgery?
You should clarify the information with the provider and determine if modifier -78 or -79 might be more appropriate.
Modifier -78 is defined as "Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period."
Modifier -79 is defined as "Unrelated procedure or service by the same physician or other qualified health care professional during the post-operative period."
Hope this helps! :)
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Thank You So Much for your help!