modifier 58 versus 78

Question: what modifier is correct for the second procedure done by the CT surgeon, modifier 58 or 78?

A patient with Pacemaker lead malfunction was having an extraction the current system and placement of a new Bi-ventricular pacing system being done by an electrophysiology physician. During the procedure, pt was found to have pericardial effusion and hypotension. CT surgery was called for emergent sternotomy to repair the bleeding source. Multiple holes and tears on SVC, innominate vein and apex of RV were repaired by the CT surgeon, patient was with severe coagulopathy. An anterior mediastinal chest tube was placed. A bipolar v wire and a wire were placed. The sternum was left open.

Two days after that the patient was taken to the OR for Mediastinum reexploration, Bi-ventricular epicardial lead placement and sternum closure. All performed by the CT surgeon.

What is the most appropriate modifier for the second procedure (Mediastinum reexploration, Bi-ventricular epicardial lead placement and sternum closure)? Is this a staged modifier 58 or an unplanned modifier78 procedure?

Thank you


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