In the last two months, we explained the use of modifier –25 to code for a significant, separately identifiable E&M service (April) and modifier –59 for a distinct procedural service (May; see www.eyenetmagazine.org/archives). We conclude this series by reviewing modifier –58. According to its CPT descriptor, modifier –58 should be used to bill for a staged or related procedure or service by the same physician during the postoperative period.

There is not a reduction in payment for the procedure; payment will be 100 percent of the allowable.

Correct Application
The following examples show how you would correctly apply modifier –58.

• During the 90-day postoperative period of 67105, 67107 repair of retinal detachment; scleral buckle is performed on the same eye. CPT code 67107–58– eye modifier.
• During the 90-day postoperative period of 67107, 67108 repair of retinal detachment; with vitrectomy and 67038 vitrectomy; with epiretinal membrane stripping are performed on the same eye. CPT codes 67038–58–eye modifier and 67108–58–51–eye modifier.
• During the global period of a trabeculectomy, a patient receives injections of 5-fluorouracil (5-FU). CPT code 68200–58–eye modifier.
• The pathology report indicates additional tissues must be removed from a malignant eyelid lesion. During the seventh day of the postop a larger excision with skin graft is performed. CPT code 14060–E2–58.

Misapplication
Descriptors for the following laser codes state one or more sessions. If a repeat laser procedure is needed to treat the same eye, it is inappropriate to append modifier –58.

• 65855 trabeculoplasty by laser surgery
• 66761 iridotomy/iridectomy by laser surgery
• 66762 iridoplasty by photocoagulation
• 66821 YAG laser capsulotomy
• 67141 retinal detachment prophylaxis by cryotherapy or diathermy
• 67145 retinal detachment prophylaxis by photocoagulation
• 67208 destruction of localized lesion of retina by cryotherapy or diathermy
• 67210 destruction of localized lesion of retina by photocoagulation
• 67218 destruction of localized lesion of retina by radiation implant
• 67220 destruction of localized lesion of choroid
• 67227 destruction extensive/progressive retinopathy by cryotherapy or diathermy
• 67228 destruction extensive/progressive retinopathy by photocoagulation

It is also wrong to append modifier –58 when you are billing for a YAG laser capsulotomy within the global period of cataract surgery. The correct modifier is –78, return to the operating room for a related procedure during the postoperative period.

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Modifier –58

Staged or Related Procedure or Service by the Same Physician During the Postoperative Period: The physician may need to indicate that the performance of a procedure or service during the postoperative period was:

1.  planned prospectively at the time of the original procedure (staged),
2.  more extensive than the original procedure or
3.  for therapy following a diagnostic surgical procedure.

This circumstance may be reported by adding modifier –58 to the staged or related procedure.

Note: This modifier is not used to report the treatment of a problem that requires a return to the operating room. See modifier –79, unrelated procedure or service by the same physician during the postoperative period.