Modifiers: 58, 78, 79

Question:

Can KZA please explain global modifiers (58, 78, 79)?

Answer:

Excellent question. Modifiers 58, 78, and 79 are used when a patient is in a global period following a prior procedure. Each modifier signals a specific circumstance to the payer, impacting reimbursement and compliance. Here is how they differ:

Modifier 58 - Staged or Related Procedure

• Used when:

  • Planned or anticipated (staged);

  • More extensive than the original procedure; or

  • Therapy is provided following a surgical procedure.

• Key Points:

  • Resets global period.

  • No payment reduction.

• Example: Removal of remaining thyroid tissue for completion thyroidectomy in the global period after a partial thyroidectomy (60260-58).

• Takeaway: The procedure is more extensive, planned, or anticipated.

Modifier 78 - Unplanned Return to the Operating/Procedure Room

• Used when:

  • The patient returns to the OR for an unplanned procedure related to the initial surgery.

• Key Points:

  • No change to the global period.

  • Payment reduction.

• Example: Patient returns to the OR following a tonsillectomy for a tonsillectomy bleed (42962-78 – Control of oropharyngeal hemorrhage; with secondary surgical intervention (typically return to the OR for operative control of bleeding).

• Takeaway: The procedure performed involves an unexpected return to the OR for a related procedure – typically a complication.

Modifier 79 - Unrelated Procedure or Service

• Used when:

  • Unrelated Procedure or Service.

• Key Points:

  • Resets global period.

  • No payment reduction.

• Example: A patient is seen at the first post-op visit 4 days after a tympanoplasty (10 day global) and now complains of hoarseness likely due to the endotracheal tube used for anesthesia. You perform a flexible laryngoscopy (31575-79, you may also want to record 99024 for the post-op visit though it of course has a $0 charge).

• Takeaway: The procedure is entirely unrelated to prior surgery.

Thank you for reaching out to KZA with your inquiry!

*This response is based on the best information available as of 09/10/26.

Microfracture?

Question:

Can microfractures be billed separately with meniscectomies when performed to promote healing? I have not been able to find any clear guidance on this. Thanks!

Answer:

Great question. While there is no CPT guidance specific to meniscectomies, CPT does address a related concept in the context of notchplasty performed to enhance the healing response for meniscal repairs. In that situation, CPT indicates that the notchplasty is considered part of the meniscal repair procedure and is not separately reportable.

Applying this same principle, a microfracture procedure performed solely to promote healing following a meniscectomy would likewise be considered inclusive to the primary procedure.

Thank you for reaching out to KZA!

*This response is based on the best information available as of 09/10/26.

Closure Following Mohs Surgery

Question:

If a patient is referred to a plastic surgeon after a Mohs surgeon performs a Mohs procedure, to perform a complex repair, do I need to add a modifier to the plastic surgeon's repair code?

Answer:

Thank you for your question. You do not need a modifier on the plastic surgeon’s repair code when the Mohs surgeon and the repairing surgeon are different specialties.

When two different physicians perform services on the same day, Medicare and most commercial payers treat them as separate providers, each with their own global surgical package. Because of that:

• The Mohs surgeon bills the Mohs codes (17311–17315).

• The plastic surgeon bills the appropriate repair code (simple, intermediate, complex, flap, graft, etc.).

• No modifier (e.g., -58, -59, -79) is required because there is no global period conflict between two different physicians.

This is consistent with standard Mohs billing guidance, which states that repairs performed by a different provider are billed normally and not considered part of the Mohs surgeon’s global package.

*This response is based on the best information available as of 09/03/26.

Are All Injections Billable?

Question:

Patient wants doctor to do injection of BPC 157 [Peptide] which the patient buys and provides. Can I bill 96372 for this service? The BPC 157 is not FDA approved and is considered experimental. Can I bill this service since no J code is available?

Answer:

While CPT 96372 technically describes the mechanical act of giving an injection, billing a payor for non-FDA-approved substances, as you've described, is not recommended. 

*This response is based on the best information available as of 09/03/26.

Posterior Pack for a Nasal Hemorrhage

Question:

I am a new ENT coder, and I am not certain how to bill this. If the emergency department physician placed a posterior pack and they came into our office and one of my doctors removes the pack, can I report CPT code 30906?

Answer:

There is no specific CPT code for removing the posterior pack. If the patient comes back in and one of your physicians removes the pack and does not replace it, you will either report an evaluation and management service or a nasal endoscopy (31231) but not both.

*This response is based on the best information available as of 08/27/26.

Interlaminar vs. Transforaminal Injections

Question:

If my physician does an interlaminar epidural steroid injection with imaging, should I be coding this as a 62321 or 62323? I know the guidelines state if a Transforaminal is done at that level to code as a 64479, but it doesn't state specifically for the interlaminar approach.

Answer:

Ensuring you select the correct injection CPT code is vitally important.

An interlaminar epidural steroid injection, whether performed for diagnostic or therapeutic purposes, is coded to either CPT 62321 or 62323, depending on the anatomic area.

Please note that CPT 62321 is for a cervical or thoracic injection, and CPT 62323 is for a lumbar or sacral (caudal) injection. Both CPT codes include needle or catheter placement with imaging guidance (i.e., fluoroscopy or CT). They do not include neurolytic substances. A transforaminal is coded by CPT 64479.

*This response is based on the best information available as of 08/27/26.