Ask Dr. Z

I was hoping you would help to clarify some global surgery modifier usage for me on the following: "Patient is brought in for AV fistula creation for dialysis access. Weeks later it is found that the AV fistula is not maturing, so the provider decides to bring the patient back electively for balloon-assisted AV fistula maturation." In a few cases I've seen, the patient is brought back for this same procedure multiple times during the post-operative period. I feel like the first balloon-assisted AV fistula maturation procedure should be coded with a -78 modifier due to a non-maturing AV fistula. In his operative report for the first procedure he indicates that the patient will be brought back again in 2-3 weeks for another balloon-assisted maturation procedure. Do you think the first procedure should be billed with a -78 modifier and then all subsequent procedures with a -58 modifier since the provider is indicating in his previous operative report that the patient will be brought back again?