360 Degree Fusion on the Same Day

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Question:

My spine surgeon did an anterior procedure followed by a posterior procedure on the same day (same patient, same anesthesia). I was told to send in two separate claims – one for the anterior procedure and the other for the posterior procedure – to get better reimbursement. I was also told to use modifier 58. Something doesn’t seem right about this. What do you think?

Answer:

You are wise to question this advice. First, modifier 58 (staged or related procedure or service by the same physician during the postoperative period) is used on the second procedure when it is performed in the global period of the first procedure. A 360 degree (or front-back) procedure is performed entirely on the same surgical day, therefore, it is inappropriate to use modifier 58 in this situation.

Sending the procedures on two separate claims to avoid the multiple procedure payment reduction is not appropriate. We expect a payment reduction for secondary stand-alone procedures when performed on the same day due to overlapping pre- and post-operative global periods and activity.