Coders can use the following tip sheet to determine the appropriate use of modifier -58. These tips are pulled from the HCPro book, JustCoding’s Guide to Modifiers: Hospital Outpatient Edition by Susan E. Garrison, CHCA, CHCA-S, CHC, CPC, CCS-P, CPAR, COC, executive vice president of Med Law Advisors in Atlanta.
Hospital inpatient, Hospital outpatient, Questions and answers
Platinum members can access a COVID-19 ICD-10-CM FAQ white paper. If you are not a Platinum member and you want to upgrade your account, please call customer service at 800-650-6787.
This sample COVID-19 query was developed by Sharme Brodie, RN, CCDS, CCDS-O, CDI education specialist at ACDIS/HCPro in Middleton, Massachusetts. Should you choose to use this sample, you adapt it to your particular programmatic needs, EHR system requirements, and organizational diagnostic criteria. CDI professionals should also ensure that all the answer options are clinically relevant for the particular patient.
The following decision tree will help you decide whether the application of modifier -22 (increased procedural services) would be appropriate in cases where the provider's work exceeded the norm.
Clinical documentation, Hospital outpatient, Physician practice
Modifier -22 (increased procedural services) frequently causes compliance headaches for revenue cycle professionals. This explanation form may be used to clarify the need for additional reimbursement in complex surgical cases where physician work exceeded the norm.