December 13, 2018
Our surgeon saw a patient in the office for a routine post-op check during the global period of an excision of a soft tissue tumor. During the visit the surgeon notes that the patient has some fullness and performs a superficial incision and drainage in the office. I have the correct CPT code, but I am wondering if I should use Modifier 58 or 79. I think the correct modifier is modifier 79 because he documents a new diagnosis “seroma”. Do you recommend modifier 58 or 79?
The reporting (or not) of this service performed in the office during the global period will be payor dependent. If the payor is Medicare, or follows Medicare rules, the visit is not reportable as this a complication of the original surgery.
If the payor follows CPT rules, and the surgeon determines this is not “typical postoperative care” then traditionally no modifiers are appended. Modifier 79 is typically reserved for an ‘unrelated’ procedure/ service at a different location. The seroma is secondary to the surgical intervention—thus if there had not been surgery, there would not be a seroma. Modifier 58 is incorrect as this is not a planned procedure, is not more extensive, and is not part of the treatment plan. Survey your private payors to determine which modifier, if any, is required.
*This response is based on the best information available as of 12/13/18.