Planned return to OR versus repeat procedure (modifier -58 vs -76)

I took a patient back to the operating room every 3 days for 15 days to do a wound-vac change, because the patient could not tolerate this at bedside. Should I append modifier -58 or -76 to the subsequent visits to the OR. Also, the payment for this is roughly $25. It doesn't seem right that I would spend my time in the OR and doing postop paperwork (total time 30 minutes) and get paid $25. Am I missing something here or am I undercoding?

Medicare guidance

The guidance I recvd from our Medicare contractor for modifier 76 is that the procedure must be performed on the same day and it is not appropriate to use modifier 76 with a surgery code. Our MAC is WPS.

Modifier -76

If you don't use -76 with surgery codes, what do you use them for?

Modifier 76

Modifier 76 is used on surgical procedures and diagnostic tests. It requires that you are performing the same procedure as the earlier procedure. It could be the same day or during the global period.

What code did you use for the original procedure, and what codes are you using for the subsequent ones?

Here is CMS's definition of when it is appropriate to use modifier 58--that is what it sounds like to me.

6. Staged or Related Procedures
Modifier “-58” was established to facilitate billing of staged or related surgical procedures done during the postoperative period of the first procedure. This modifier is not used to report the treatment of a problem that requires a return to the operating room.
The physician may need to indicate that the performance of a procedure or service during the postoperative period was:
a. Planned prospectively or at the time of the original procedure;
b. More extensive than the original procedure; or
c. For therapy following a diagnostic surgical procedure.
These circumstances may be reported by adding modifier “-58” to the staged procedure. A new postoperative period begins when the next procedure in the series is billed.

modifier -76

I performed a wound vac application 97605 along with other procedures (ie incision and drainage, exam under anesthesia, etc). But at this time I planned on taking the patient back to the OR after a few days to change the dressing under anesthesia (again code 97605 along with exam under anesthesia). At this setting I decided to take the patient back to the OR after another few days for another wound vac dressing change (again code 97605). This time I had to perform manual disimpaction of impacted stool. For the 97605 codes on the second and third visits to the OR do I use modifier 76 or 58?

modifier -76

97605 has no global days, so doesn't need any modifier.

modifier 76

Thanks. That makes sense now. But just for the sake of argument...lets say I repeated a procedure 5 days later that had a global period of 90 days...but I planned on repeating it at the original operation...would this be modifier -76 or -58. Thanks again.

Modifier 76 versus 58

It seems to me there if you planned to take the patient back to repeat the very same procedure, both CPT modifiers meet the criteria.

They perform the same function: allow you to get paid for the surgery, during a global surgical period for another case.

I believe they both re-set the global period from that date.

Both would be true.

You can submit both modifiers 58 and 76, or I believe there is a way to use modifier 99 to indicate that you are appending multiple modifiers.

I think I would use modifier 58 in preference to modifier 76, but I don't have a citation to support this.