Modifiers

“The NCCI edits talk about having calluses on toes 2-5 that are proximal to the distal interphalangeal joint (DIPJ). However, what about the hallux? We have diabetic patients with class findings that meet the criteria to debride hallux toenails. Occasionally, these patients also have a callus at the medial interphalangeal joint (IPJ). Payment is being denied on appeal due to the rule about not being a separate toe or proximal to the DIPJ. However, the hallux does not have two joints – just the IPJ. Is the IPJ thus considered the most distal joint? And debriding calluses either plantar to the IPJ or medial to the IPJ is included in the code?”

What are the definitions of Modifiers 58, 76, 77, 78, 79 and how do they differ?

Proper Use of the 59 Modifier