Keeping Compliant With Modifier Use

By Susan Dooley

Heres one of the truths of medical coding: Modifiers matter. Coders use modifiers to change, or modify,
a codes 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 doesnt get the documentation; usually they just get the CMS
1500 claim form electronically, Cobuzzi said. The payer doesnt 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 ICD10-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 well tell you how you can glean Cobuzzis modifier wisdom by attending her AudioEducator
webinar, so stay tuned.

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

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.
Heres 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 patients 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 wasnt available to perform the colectomy that same day, you wouldnt need to append
modifier 58 to 44140.

What About You?

Sometimes it seems like theres 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.
Youll 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. Theres so much more packed into this 90-minute prerecorded AudioEducator
presentation. Register today and learn at your leisure. Contact us!

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

Contact Us:
Name: Sam Nair
Title: Associate Director Enterprise Practice
Email: shyamn@codinginstitute.com
Direct: 704 303 8150

Desk: 866 228 9252, Ext: 4813

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

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