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Network Matters
News and Information for the
Harvard Pilgrim Health Care Network

April 2019

Correct Use of Modifiers 58, 78, and 79


Harvard Pilgrim would like to offer some reminders regarding the correct use of the modifiers 58, 78, and 79 for our commercial members. These modifiers are used in conjunction with procedures performed within the global period of another procedure, but have commonly misunderstood differences that can often lead to misuse.

Modifier 58

This modifier is defined as follows: staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period

Correct use:

  • To report a staged procedure planned at the time of the original procedure
  • For therapy following a diagnostic procedure
  • When performing a second or related procedure during the postoperative period
  • When appended or applied to a procedure with a 10- or 90-day global surgical period that requires a return to the operating room for a procedure
  • When the staged procedure is more extensive than the original procedure (Example: CPT code 19307-RT is performed during the global period of CPT 19125-RT. CPT code 19307 should be reported with modifier 58 as it is considered a more extensive procedure.)

Incorrect use:

  • Appending the modifier to a procedure with a 0-day global surgical period or where the global concept does not apply
  • Appending to procedure code that indicates “one or more sessions” (i.e. CPT 67028, Destruction of localized lesion of retina, one or more sessions)
  • Reporting the treatment of a complication from the original surgery (see Modifier 78)
  • When the procedure is unrelated to the original procedure

Modifier 78

This modifier is used to report a “return to the operating room for a related procedure during the postoperative period.”

Correct use:

  • When a second procedure is necessary due to a complication during the postoperative period that requires a return trip to the operating room
  • When the procedure was unplanned

Incorrect use:

  • When the procedure is unrelated to the original procedure
  • On procedures performed in the office location
  • When the procedure is not within the postoperative period

Modifier 79

This modified is used to report an “unrelated procedure or service by the same physician during a post-operative period.”

Correct use:

  • When the procedures are unrelated but are being performed by the same physician during the postoperative period

Incorrect use:

  • When the procedure is related to the original surgery or a staged surgery
  • If appended to a procedure code when the global concept doesn’t apply

For more information, please refer to Harvard Pilgrim’s CPT & HCPCS Level II Modifiers Payment Policy.

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Correct Use of Modifiers 58, 78, and 79

PUBLICATION INFORMATION

Robert Farias,
Senior Vice President, Corporate Network Strategy

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Editor

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Writer

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Production Coordinator