Question Staged procedure performed the same day


Huntington Station, NY
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I work for spine surgeons. Many times when a patient requires both anterior and posterior fusions. Rather than subjecting our patient to two surgeries on two different days, we perform the first procedure completely (anterior portion), then flip the patient over, create new incision sites and complete the second stage surgery (posterior portion). I am aware if we performed these procedures on two separate days, all we would need to do is append modifier -58 and we will receive 100% payment on both primary codes (anterior 22558 and posterior 22633). When the procedure is performed the same day, should I be appending modifier -58,59 to get this separate incision code paid at 100%, or is it that being we did the surgeries on the same day, all codes except the highest paying code are subjected to reductions?


True Blue
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A second procedure done on the same day is not a staged procedure - by definition, staged procedures are performed during the global period, which does not begin until the day following the original procedure - so modifier 58 is not correct in the situation you are describing. Modifier 59 can be used to indicate that a procedure which would normally be incidental or bundled was performed on a separate site or via a separate incision, but this modifier only overrides bundling edits - it does not affect multiple surgery reductions.

Under almost all payer policies, all procedures performed on the same date are going to be subject to multiple procedure reductions unless it involves an unplanned return to the operative room (modifier 78) which implies a separate operative session. If your providers are performing both procedures in the same operative session, then multiple procedure reductions are appropriate and there isn't any justifiable or effective way to try to avoid them.