Reader Questions:
58 Modifier Marks Staged Surgery
Published on Thu Feb 17, 2011
Question: My surgeon does a vein transposition as a staged procedure after creating a direct anastomosis. Can I bill the transposition as a staged procedure?New Jersey SubscriberAnswer: Yes, you can bill the vein transposition (36819, Arteriovenous anastomosis, open; by upper arm basilic vein transposition) as a staged procedure following the direct anastomosis creation (36821, ...direct, any site [e.g., Cimino type], [separate procedure]).That is, assuming that your surgeon did both procedures in full. Having a surgeon perform a direct anastomosis for more immediate access followed by a subsequent transposition would not be unusual.You should use modifier 58 (Staged or related procedure or service by the same physician during the postoperative period) with 36819.On the other hand, if the surgeon performed the transposition because of a complication in the direct fistula, modifier 78 (Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure [...]