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Hi Everyone, CPT Modifier 58, 59, 78, 79, 24 Modifiers 58, 78, 59, 79, and 24 are CPT modifiers applied to surgery claims. They each have very specific, though related definitions. They often cause confusion, especially between modifiers 58 and 78, but also among 59, 79, and even 24. Here are the definitions, according to Current Procedural Terminology (CPT): ✓ Modifier 58 Definition: “Staged or related procedure or service by the same physician during the post-operative period.” ✓ Modifier 78 Definition: “Unplanned return to the operating or procedure room by the same physician following initial procedure for a related procedure during the post-operative period.” ✓ Modifier 79 Definition: “Unrelated procedure or service by the same physician during a post-operative period.” ✓ Modifier 59 Definition: “Distinct Procedural Service: Under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-E/M services performed on the same day…” ✓ Modifier 24 Definition: “Unrelated E/M service by the same physician during a post-operative period” Knowing when to choose modifier 58 over 78 or 79 over 78 is vital. Why? Using the wrong modifier can mean denied claims. The different modifiers also carry varying reimbursement schemes. For instance, Modifiers 59 and 78 can reduce Medicare reimbursement below 100%. • 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. • Modifiers 59 and 79 can be confused as well. Both can refer to unrelated procedures by the same physician. However, 79 focuses on the post-operative period, while 59 centers more specifically around same-day or same-session procedures. • Finally, modifier 24 covers only E/M services by the same physician during the post-op period. • Billing with the right modifiers means less denied claims and higher reimbursement. That means health care workers can ultimately save money for employers. The decision tree below aims to simplify the choice between modifiers 58, 78, 79, and 59. 👉 Follow me for more updates: Shorya Rastogi 👍 Like ✍ Comment 🤝 Share #winwithbestwishes #CPTModifiers #SurgeryClaims #SurgeryCoding #ModifierUsage #CleanClaims #AvoidDenials #Reimbursement
RAVI CHHONKER
2mo
Nice information Shorya.. However further breakdown is available for modifier 59. Use modifiers XE, XS, XP, or XU whenever possible instead of modifier 59. These modifiers are defined as: XE: Separate encounter XS: Separate structure XP: Separate practitioner XU: Unusual non-overlapping service
Suchit Rastogi
2mo
Your content is always so interesting and knowledgable!
Mohd Faisal
2mo
Very informative 👏 Appreciated sir
Aftab Javedi
2mo
Very informative
Shalini Biral
2mo
Very informative
Neeraj Dubey
2mo
Very informative
CPT modifiers comparison for surgery claims
Neetu Pal
2mo
Thanks for sharing
Himani Singhal
2mo
Very helpful
Director of Operations at Accurio
2moVery informative. However, in addition, Modifier 59: Indicates distinct services, not just unrelated ones. It’s also used to separate the bundled procedures for correct billing. Modifier 58: Applies to planned, staged procedures. Modifier 78: For unexpected returns to surgery due to complications. Modifier 59: Covers distinct same-day procedures. Modifier 79: Applies to unrelated procedures during the post-op period. Regarding reduced Medicare reimbursement, Modifier 78 may lead to lower payments. Modifier 59 doesn’t reduce payment but ensures separate billing for distinct services.