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’s 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: Definitive fracture treatment following debridement of an open fracture the day prior.

  • Modifier 58 is appended to the ORIF code (XXXXX-58) – This modifier reflects that this procedure is both more extensive and planned.

• 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 for excision and closure of extensive wound dehiscence.

  • Modifier 78 is appended to code (13160-78) – This modifier reflects an unplanned return to the OR to treat the wound complication associated with the initial surgery.

• 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: Left CTR performed a month after Right CTR.

  • Modifier 79 is appended to code for left (64721-79-LT) – This modifier reflects that this procedure is unrelated to the right-sided procedure.

• 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 09/17/26.

Inferior Dermal Flap

Question:

Is there a code for an inferior dermal flap in breast reconstruction?

Answer:

An inferior dermal flap may be reported using the Adjacent Tissue Transfer (ATT) code set (CPT 14xxx), provided the documentation supports.  According to CPT Assistant guidance, the adjacent tissue transfer codes should be used for a de-epithelialized autoderm flap, based solely on the transposed area.

However, according to Medicare’s National Correct Coding Initiative (NCCI) Policy Manual, adjacent tissue transfer or rearrangement is considered included in breast reconstruction procedures when performed as part of those services.

Excerpt from the NCCI Manual:

“Breast reconstruction procedures (CPT codes 19357–19369) include adjacent tissue transfer or rearrangement procedures (e.g., CPT codes 14000, 14001) if performed. An adjacent tissue transfer or rearrangement procedure may be reported on the same day as a breast reconstruction procedure only if it is performed at a different site unrelated to the breast reconstruction.”

Key Point: According to Medicare guidelines, ATT codes are not separately reportable when performed as part of breast reconstruction, as outlined in the NCCI Manual, Chapter III. If you apply these guidelines universally to all payors, the ATT code would not be reported.

*This response is based on the best information available as of 08/20/26.

Breast Reduction with Lipo

Question:

I am looking for KZA’s recommendation. If both a breast reduction (19318), and a suction-assisted lipectomy (15877) is also performed can both procedures be reported?

Answer:

Suction-assisted lipectomy performed to enhance the outcome of a breast reduction is considered part of the primary procedure and is not separately reportable. Additionally, according to NCCI edits, code 15877 is bundled with 19318. Therefore, if the documentation supports both open excision of breast tissue for reduction and suction-assisted lipectomy, it would be appropriate to report only 19318.

Thank you for reaching out to KZA with your inquiry.

*This response is based on the best information available as of 07/09/26.

ICD-10 – Defect following Mohs

Question:

Can you please advise? Our practice performs reconstructions of defects following Mohs surgery. For context, we typically evaluate the patient prior to surgery to discuss reconstruction. What is the appropriate ICD-10 coding to reflect this wound in the setting of reconstruction?

Answer:

To accurately report this scenario, multiple ICD-10 codes are required:

1. Z48.1 - Encounter for planned postprocedural wound closure.

2. Z42.8 - Encounter for other plastic and reconstructive surgery following a medical procedure.

A third ICD-10 code should be selected based on the patient’s diagnosis history, specifically whether there is an active malignant neoplasm or a personal history of neoplasm.

Example: Same Day Mohs surgery and reconstruction

1. Z48.1 – Encounter for planned postprocedural wound closure.

2. Z42.8 – Encounter for other plastic and reconstructive surgery following a medical procedure.

3. Appropriate C-code for the malignancy.

Key Considerations:

• The malignancy code is not listed as the primary diagnosis because the service being performed is reconstruction, not treatment of the cancer.

• Codes from Chapter 19 of ICD-10 (S00–T88, injury range) are not appropriate, as they are designated for traumatic injuries and do not apply in this clinical context.

Thank you for reaching out to KZA with your inquiry.

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

19432? Removal and Reinsertion of Implant

Question:

My surgeon wants to report 19342 when a patient develops a seroma post‑reconstruction. The implant is removed, the seroma is drained, and the same implant is reinserted. Is this appropriate?

Answer:

Great question! The Breast Repair and/or Reconstruction subsection guidelines provide specific direction regarding the use of code 19342.

According to the guidelines:
“In delayed reconstruction, an implant is placed at any date separate from the mastectomy (19342). This includes placement of any new implant or replacement of an existing implant within the mastectomy defect or reconstructed breast.”

In the scenario described, the implant is temporarily removed to allow drainage of the seroma and then reinserted. Because the same implant is returned to the pocket—and no new or replacement implant is placed—19342 would not be appropriate under the guidelines.

Thank you for reaching out to KZA!

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

1500X Surgical Prep & 14XXX ATT Codes

Question:

Is it appropriate to bill surgical preparation codes (1500X) with adjacent tissue transfer codes (14XXX)?

Answer:

Yes. Surgical preparation codes may be reported with adjacent tissue transfer (ATT) codes when the documentation supports that a separate and medically necessary wound‑bed preparation service was performed.

The Skin Replacement Surgery subsection guidelines state that “Surgical preparation codes 15002–15005 for skin replacement surgery describe the initial services required to prepare a clean and viable wound surface for placement of an autograft, flap, skin substitute graft, or for negative pressure wound therapy.”

Since the definition specifically includes flap and adjacent tissue transfer, which is classified as a flap procedure, the combination is appropriate when both services are distinctly documented and not considered inherent to the ATT itself.

Thank you for reaching out to KZA!

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