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.

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.

Instrumentation for CPT 69210

Question:

For CPT 69210, is suction, by itself, considered instrumentation for this procedure code?

Answer:

According to the AAO-HNS, using CPT code 69210 is reported based on what instruments are used to remove the impacted ear wax.  Instrumentation is defined as the use of an otoscope and instruments such as wax curettes, wire, loops or suction specific ear instruments (e.g., cup loops, right angle hook) or a similar tool designed for controlled wax extraction. Documentation should indicate the equipment used to provide the service.  

*This response is based on the best information available as of 07/16/26.

Coding for a Fess Procedure

Question:

What is the recommended CPT coding for a nasal/sinus endoscopy with a total ethmoidectomy, frontal sinus exploration with removal of tissue from frontal sinus, a sphenoidotomy with removal of tissue from sphenoid, and a maxillary antrostomy with removal of tissue from maxillary sinus?

Answer:

For a functional endoscopic sinus surgery (FESS) involving the procedures you listed, the recommended CPT codes are:

• Total ethmoidectomy (anterior + posterior): 31259 – Nasal/sinus endoscopy, surgical; with ethmoidectomy, total (anterior and posterior) including sphenoidotomy, including removal of tissue from the sphenoid sinus.

• Frontal sinus exploration with removal of tissue: 31276 – Nasal/sinus endoscopy, surgical; with frontal sinus exploration, including removal of tissue from frontal sinus.

• Maxillary antrostomy with removal of tissue: 31267 – Nasal/sinus endoscopy, surgical; with maxillary antrostomy, with removal of tissue from maxillary sinus.

CPT code 31259 is a combination code that includes anterior and posterior ethmoidectomy and the sphenoidotomy which includes the removal of tissue from the sphenoid sinus. These codes are separate and distinct procedures because they involve different sinus cavities, so they are typically reportable together (when medically necessary and documented). If performed bilaterally, append modifier -50 (or follow payer-specific bilateral reporting rules). The “with removal of tissue” codes (31267, 31276, 31259) are appropriate since tissue removal is documented. Do not separately report diagnostic endoscopy (31231) — it is included in the surgical procedures.

*This response is based on the best information available as of 06/04/26.

CPT Code 42842 vs. 42844

Question:

I have a question. Which CPT code would I use? If local tissue rotational flaps isn’t done, would we report CPT 42842 or CPT 42844? Is it appropriate to bill CPT 42844 if local tissue rotational flaps aren't performed? Per documentation. "We then commenced with primary closure of the defect with 3-0 Vicryl in a horizontal mattress fashion."

Answer:

Thank you for your great question. CPT code 42844 would not be appropriate code based on the documentation as written. Your note states: "primary closure of the defect with 3-0 Vicryl in a horizontal mattress fashion." This describes a primary/direct closure (approximating wound edges with sutures), not a local tissue rotational flap. These are fundamentally different techniques:

• Primary closure = suturing wound edges together

• Local tissue flap = mobilizing and rotating/advancing adjacent tissue to cover a defect (e.g., rotation flap, advancement flap, transposition flap)

A local tissue flap requires distinct documentation of flap design, elevation, rotation/advancement, and inset — none of which are described here. Based on the documentation the correct code to report is 42842.

*This response is based on the best information available as of 05/07/26.

Removing a Nasal Pack

Question:

I have looked everywhere and cannot find a CPT code for removing a posterior nasal pack. I found CPT code 30906 for reporting control of a nasal hemorrhage when removing and replacing the pack. Can I report 30906 with Modifier 52 since my doctor is just removing the posterior nasal pack?

Answer:

No, you do not report 30906. There is not a code for removing a posterior pack unless you are replacing the pack at the same time. If you are only removing a pack then report an E/M CPT code or nasal endoscopy code (31231) whichever is more appropriate.

*This response is based on the best information available as of 04/02/26.