Modifier 58 or 78

Modifier 58 or 78

October 31, 2019

Question:
We have a patient scheduled for manipulation under anesthesia for arthrofibrosis during the post-operative period for a total knee arthroplasty. The patient was informed prior to the TKA surgery that they may need to have the manipulation done post op. Is it appropriate to use modifier 58 for the manipulation because it was an anticipated service, or should we use modifier 78 because arthrofibrosis is a complication?

Answer:
We appreciate that the surgeon discussed with the patient the possible outcomes following the total knee arthroplasty.

Modifier 58 is reported when a subsequent procedure performed during aglobal period is staged, planned, or more extensive than the original procedure performed to treat the condition.

In the scenario presented, while the physician discussed the potential for arthrofibrosis with the patient, the service does not meet the definition of staged, planned or more extensive procedure than the total knee arthroplasty.

Report the surgical CPT code for manipulation under anesthesia with modifier 78, Unplanned Return to the Operating/Procedure Room by the Same Physician or Other Qualified Health Care Professional Following Initial Procedure for a Related Procedure During the Postoperative Period.

*This response is based on the best information available as of 10/31/19.

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