Anterior & Posterior arthrodesis same session

belmontg

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Hi
I need help on anterior & posterior arthrodesis during the same session by the same surgeon. One of our doctors is trying to bill this combination of surgeries using modifier 58 on the posterior arthrodesis, because a different billing company told him he could. It has been my understanding, if both procedures were performed during the same session, modifier 51 would be the appropriated modifier to use.

Can anyone help?
 

penguins11

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You absolutely do not bill with a modifier 58. The definition of modifier 58 is stated or related procedure during the postoperative period. Since the patient never left the OR there is no post op period. You would bill the second code with a 51 modifier and would bill them all on the same charge ticket not as two separate claims. If the dr disagrees tell him that the patient was not put under anesthesia twice, it was one operative session and the did not have two different pre-op periods and post op periods.
 

penguins11

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We do 360's all the time too. In the AANS anual coding seminar, they tell you to use a 51 on the secondary code. There are no edits that prevent the billing of anterior and posterior fusions together and as modifer 59 if overused can be a "red flag" to insurance companies and there are no bundling issues and the payment is the same, 51 is more appropriate.
 
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