"Provider performed I&D -10060. The patient returned 4 days later because the wound was still bothering them and provider performed I&D again at the same site. 10060 was billed again and of course denied. Is this just not payable as it's within the global period, same issue or can we add a 58 modifier?"
CPT 10060 carries a 10 day postoperative global period in the CMS Physician Fee Schedule Relative Value File. Medicare payers and most other third party payers in the US use this to determine postoperative global periods. Generally, payment for a procedure that carries a global period includes payment for postoperative care provided during the global period. There are exceptions to this. You are describing the same procedure performed at the same site by the same provider 4 days after the initial procedure was performed. The most appropriate CPT Modifier for this is the 76 Modifier:
76 Modifier -Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional
You can consider appending the 76 Modifier to this repeat service if the documentation supports the medical necessity of repeating the service. It is not common for a repeat I&D to be medically necessary 4 days after the initial I&D.
You asked about the 58 Modifier.
The 58 Modifier may be used for three different situations:
1. Procedure during postoperative period was planned or anticipated (staged)
2. Procedure during postoperative period was more extensive than the original procedure
3. Procedure during postoperative period was for therapy following a surgical procedure.
Your description does not indicate any of these are appropriate for this situation.
Jeffrey D. Lehrman, DPM, FASPS, MAPWCA, CPC, CPMA
Certified Professional Coder
Certified Professional Medical Auditor
Lehrman Consulting, LLC