If a staged procedure is denied, resubmit with 58 or appeal with both operative notes.
If a claim is denied, appeal with the operative note showing a separate condition. UnitedHealthcare’s Global Days Policy (2026R0005E, version dated September 20, 2026) also uses 79 for clearly distinct procedures during the postoperative period. Our guide to
Why it matters in orthopedics
Staged care is routine in orthopedics. Surgeons place a temporary external fixator and return for definitive fixation once swelling settles, perform two-stage revisions of infected joint replacements, or move from a diagnostic arthroscopy to an open procedure. When the second procedure falls inside the first procedure’s global period, Medicare denies it unless it carries modifier 58, modifier 78 or modifier 79 (Medicare Claims Processing Manual, Chapter 12, §40.4.A).
How it works
Use 58 when the procedure during the postoperative period was planned prospectively or at the time of the original procedure, was more extensive than the original, or was therapy following a diagnostic surgical procedure (§40.2.A.6; CMS global surgery booklet MLN907166, December 2025).
A new postoperative period begins when the next procedure in the series is billed.
58 is not used to treat a problem that requires a return to the operating room; that is modifier 78.
When a less extensive procedure fails and a more extensive one is needed, Medicare pays the second procedure separately (§40.1.B).
NCCI lists 58 among the modifiers that can bypass procedure-to-procedure edits that allow modifiers. When diagnostic arthroscopy findings lead to an open procedure, NCCI allows the diagnostic arthroscopy to be reported, with 58 showing that the procedures were staged or planned (NCCI Policy Manual, Chapter IV, Section E, revised January 1, 2026).
Situation during the global period | Modifier | New global period? |
|---|---|---|
Planned or staged, more extensive, or therapy after a diagnostic procedure | 58 | Yes |
Unplanned return to the operating room for a related problem | 78 | No |
Unrelated procedure | 79 | Yes |
Orthopedic example
A 45-year-old patient with a high-energy tibial plafond (pilon) fracture has a spanning external fixator placed while the soft tissues recover, and the operative note records that definitive internal fixation is planned. When the same surgeon performs the definitive fixation two weeks later, the fixation code is billed with modifier 58. A new global period begins with the definitive procedure.
Common denial triggers
58 used for an unplanned return to the operating room to treat a complication, which calls for 78.
58 used for an unrelated procedure, which calls for 79.
The first operative note does not document the staging plan.
The modifier is left off, so the second procedure is denied as part of the first procedure’s global package.
How to prevent or fix
Document the staging plan in the first operative note and the consent, for example “definitive fixation planned once soft tissues allow.”
Choose among 58, 78 and 79 by asking three questions: was it planned, was it an unplanned related return to the operating room, or is it unrelated?
If a staged procedure is denied, resubmit with 58 or appeal with both operative notes.
For related denial patterns, see our guide to common orthopedic claim denials.
Frequently asked questions
Does modifier 58 start a new global period?
Yes. Medicare’s Claims Processing Manual states that a new postoperative period begins when the next procedure in a staged series is billed with modifier 58. Track the new global period in your practice management system so that routine follow-up for the second procedure is not billed as separate visits, and unrelated visits still get the right modifier.
Does a staged procedure have to be in the operating room to use modifier 58?
No. Medicare’s description of modifier 58 turns on whether the procedure was planned, more extensive, or therapy after a diagnostic procedure, not on where it was performed. The operating-room requirement belongs to modifier 78, which covers unplanned returns to the operating room for related problems during the postoperative period.
Is modifier 58 needed after the first procedure’s global period ends?
No. Modifiers 58, 78 and 79 identify procedures performed during another procedure’s postoperative period. Once that global period has ended, a later staged procedure is billed without modifier 58, and it carries its own global period from the date it is performed.
Guides that cover this term
Related terms
Sources
Medicare Claims Processing Manual, Chapter 12: Physicians/Nonphysician Practitioners — CMS, Rev. 13753, issued May 7, 2026
Global Surgery (MLN907166) — CMS Medicare Learning Network, December 2025
Medicare NCCI Policy Manual, Chapter I: General Correct Coding Policies — CMS, revision date January 1, 2026
Medicare NCCI Policy Manual, Chapter IV: Surgery: Musculoskeletal System, CPT Codes 20000–29999 — CMS, revision date January 1, 2026
This entry is educational and is not legal, coding-compliance or billing advice. Payer rules change often, so confirm requirements with the payer before you bill. CPT® is a registered trademark of the American Medical Association; code descriptions here are Rette’s plain-language summaries.