Medical image created by Peoplecreations – Freepik.com

Documenting the events of a patient visit is not always the simplest and most straightforward of processes. Many variables affect which information must be included in order to report a procedure or service accurately. Global periods are one of those variables. A global period is the amount of time before, during and after a surgical procedure during which the patient’s care is covered. When a provider performs a procedure or service on a patient who is within the global period of a previous procedure, the new procedures must be distinguished by a modifier, usually modifier 24, 58, 78 or 79.

Minor surgical procedures include either a zero or 10-day post-op period, starting the day of the surgical procedure. Major surgical procedures include a 90-day post-op period, starting either the day before or the day of the surgical procedure. When patient care falls within either the 10-day or 90-day global period, new services must be documented with a post-op modifier.

When Not to Use Modifiers 24, 58, 78 and 79

Providers are not separately reimbursed for providing routine post-op care during the post-op period, even if the procedure is reported with a post-op modifier.

Routine post-op care includes the following services:

  • Treatment for complications following a procedure, including all additional medical and/or surgical services that do not involve a return trip to the operating room
  • Critical care services for seriously injured or burned patients
  • Post-op visits, including follow-up E/M visits related to the patient’s recovery following surgery
  • Pain management related to the surgical procedure
  • Select supplies
  • Removal of sutures/staples, lines, wires, tubes, drains, casts and splints
  • Dressing changes
  • Local incisional care
  • Insertion, irrigation, and removal of urinary catheters
  • Routine peripheral intravenous lines
  • Nasogastric and rectal tubes

Basics Rules

Modifiers 24, 58, 78, and 79 share the following usage guidelines:

  1. The patient is already in a post-op period for a previous surgery when a new procedure is performed.
  2. The new procedure is performed by the same physician who performed the previous surgery.
  3. Modifiers apply to the new procedure being performed that day.

Modifier 24 – Unrelated evaluation and management by the same physician during a post-op period

  • Use with Evaluation and Management (E/M) services (99201-99499) or general ophthalmological services (92002-92014) only
  • Use when evaluating a new problem or injury that is unrelated to the original procedure. The new problem may involve a different diagnosis than the original procedure, or it could be the same diagnosis for a different anatomical site.
  • Do not use to report routine post-op care.

Modifier 58 – Staged/related procedure by the same physician during a post-op period

  • Apply to any subsequent, planned surgical procedures when more than one surgery is required to treat a problem or injury.
  • Do not apply modifier 58 to the original surgery.
  • May be used on therapeutic procedures that are performed following a diagnostic procedure.
  • Do not use on surgical procedures whose definition specifies one or more sessions.

Note: The new surgical procedure starts a new global period.

Modifier 78 – Unplanned return to the operating room by the same physician following the initial procedure for a related procedure during the post-op period

  • Use when a unplanned, subsequent surgery must be performed to treat complications related to the initial procedure (i.e. excessive bleeding or infection).
  • Do not use if the patient is in the same operative session as the original surgery.

Note 1: The new procedure does not restart or begin a new global period.

Note 2: Modifier 78 is a payment modifier. Procedures with modifier 78 are
reimbursed only for the intraoperative portion of the procedure (usually 70 to 80
percent of the physician fee schedule). Expect to see a payment reduction on
procedures with modifier 78.

Modifier 79 – Unrelated procedure by the same physician during the post-op period

  • Use with new surgical procedures performed on patients who are in a post-op period from a different, unrelated surgery.
  • Use when reporting identical procedures that are not performed on the same day and are not repeats of the same procedure on the same anatomical site.

Note: The new surgical procedure starts a new global period.