On this page
- What Is Modifier 58?
- When Does Modifier 58 Apply in Eye Care?
- How Does Modifier 58 Work for Staged Laser Treatment?
- How Is Modifier 58 Different From 78 and 79?
- What Does Not Qualify for Modifier 58?
- What Does a Modifier 58 Claim Look Like?
- How Does Modifier 58 Change the Global Period?
- Why Do Modifier 58 Claims Deny?
Key takeaways
- Modifier 58 covers 3 situations, which are a planned or staged procedure, a more extensive procedure and therapy after a diagnostic procedure.
- The procedure billed with modifier 58 is paid at the full fee schedule amount and starts its own global period.
- A staged procedure must be planned at the first procedure, and the record should say so.
- An unplanned return to the operating room for a complication uses modifier 78, not 58.
What Is Modifier 58?
Modifier 58 is a CPT modifier for a staged or related procedure performed by the same physician or group during the postoperative period of an earlier procedure. It tells the payer the second procedure is not part of the first one's global package, so it is paid separately.
CPT allows modifier 58 in 3 situations. The procedure was planned at the time of the first one, it was more extensive than the first one or it was therapy that followed a diagnostic procedure. Modifier 58 is one of the global period modifiers listed in ophthalmology modifiers, alongside 24, 78 and 79.
When Does Modifier 58 Apply in Eye Care?
Modifier 58 applies in eye care when a second procedure on the same eye was planned from the start, goes further than a first attempt or treats what a diagnostic procedure found. The table shows one eye care example for each of the 3 CPT situations.
| CPT situation | What it means | Eye care example |
|---|---|---|
| Planned or staged | The second procedure was planned at the first one | A second planned PRP session in the same eye inside the 10-day global of 67228 |
| More extensive | The second procedure goes further than the first | Vitrectomy repair after a pneumatic retinopexy fails to reattach the retina |
| Therapy after diagnosis | Treatment follows a diagnostic procedure | Excision of an eyelid lesion after a biopsy confirms the diagnosis |
The therapy example needs modifier 58 only when the biopsy code has a 10 or 90-day global period. If the first procedure has a 0-day global, the second one needs no modifier.
How Does Modifier 58 Work for Staged Laser Treatment?
Staged laser treatment uses modifier 58 when the sessions in the same eye are planned in advance and a later session falls inside the global period of an earlier one. Panretinal photocoagulation for proliferative diabetic retinopathy is the most common example.
Medicare gives 67228 a 10-day global period. A second session in the same eye on day 7 is billed 67228-58-RT. A session on day 14 is outside the global period and needs no modifier 58.
Does every multi-session laser need modifier 58?
No. Codes whose descriptor includes "one or more sessions" cover every session in the treatment, so later sessions are not billed again. Check the descriptor for each laser code before billing a second session.
What should the first note say?
The note for the first session should state that more sessions are planned and why, such as treating the remaining retina in stages. Without that plan, a later session looks unplanned to an auditor.
How Is Modifier 58 Different From 78 and 79?
Modifier 58 is for a planned or related procedure, modifier 78 is for an unplanned return to the operating room for a related problem and modifier 79 is for an unrelated procedure. All 3 apply during a global period, and they pay differently.
| Factor | Modifier 58 | Modifier 78 | Modifier 79 |
|---|---|---|---|
| Relationship to the first procedure | Related, planned or more extensive | Related, unplanned | Unrelated |
| Operating room needed | No | Yes, or a dedicated procedure room | No |
| Medicare payment | Full fee schedule amount | Intraoperative portion only | Full fee schedule amount |
| New global period | Yes | No | Yes |
| Eye care example | Planned second PRP session | Wound leak repair after cataract surgery | Cataract surgery on the second eye |
Using 78 when 58 fits lowers payment, and using 58 for a complication is a common audit finding.
What Does Not Qualify for Modifier 58?
A procedure does not qualify for modifier 58 when it treats a complication, treats the other eye or falls outside the global period. These are the 4 most common misuses.
- A return to the operating room for a complication, which uses modifier 78
- A procedure on the fellow eye, which uses modifier 79 with RT or LT
- A procedure after the global period has ended, which needs no modifier
- Treatment of a complication in the office, which Medicare includes in the global package
The test is whether the second procedure was part of the plan or a natural next step for the same problem. If it fixes something that went wrong, it is not modifier 58.
What Does a Modifier 58 Claim Look Like?
A modifier 58 claim bills the second procedure with modifier 58 followed by the eye modifier, with the same diagnosis as the first procedure. The example shows planned PRP in the right eye for proliferative diabetic retinopathy.
| Date | Claim line | Diagnosis |
|---|---|---|
| Day 1 | 67228-RT | E11.3591, type 2 diabetes with proliferative retinopathy without macular edema, right eye |
| Day 7 | 67228-58-RT | E11.3591 |
Payment modifiers come before the eye modifier, so the line reads 67228-58-RT, not 67228-RT-58. The day 7 session starts a new 10-day global period for that eye.
How Does Modifier 58 Change the Global Period?
A procedure billed with modifier 58 starts a new global period of its own length, which runs alongside what remains of the first one. Visits for the same problem in that window are part of the new procedure's package.
A more extensive surgery can also lengthen the global period. When a 90-day vitrectomy follows a 90-day pneumatic retinopexy, the patient's post-op care runs 90 days from the vitrectomy date. Track both end dates so that unrelated visits are billed with modifier 24 only when they fall inside a global period.
Why Do Modifier 58 Claims Deny?
Modifier 58 claims deny most often because the plan is missing from the record, the eye modifier is missing or the payer reads the procedure as a complication. These steps prevent most of them.
- Write the plan. State future sessions in the first procedure note.
- Add the eye. Bill RT or LT after modifier 58 on every eye procedure.
- Keep the diagnosis. Use the same condition as the first procedure.
- Check the payer. Some Medicaid and commercial plans use longer global periods for laser codes.
Our ophthalmology medical coding services track every global period and check each staged procedure before the claim is sent.