I am billing subsequent casts for patients with fractures using modifier 58. (Casts were changed for X-ray purposes). A rep from our FI at CMS is telling me I should be using modifier 78(return to Op Room). I explained the patients aren't going back to the OR and so that's inappropriate. She then tells me that it doesn't have to be an OR to use that modifier. (I think she just wants us to take the reduction using the 7
So I ask her to give me the guidelines she's using to make that determination, and what her definition of an OR is. She sends me a letter stating the there's nothing in the IOM(internet online manual) stating that an OR can be an office, but in conferring with the medical review staff, she was correct that the op room does not have to be in the hospital setting. (which is fine....but this doc doesn't have an OR in his office!) I don't think her usage of modifier 78 is correct, and now I find out she's giving coding workshops for modifier usage. Am I wrong? And if not, what recourse do I have in obtaining the truth? Thanks in advance for any help.
Debbie
Debbie
