Neurosurgery Coding Alert

In some cases, surgeons may provide separately reportable, "staged" procedures during the global period of a previous surgery, or the surgeon may perform only a portion of the care included in the global surgical package. In any of these circumstances, the surgeon may receive the payment he or she deserves by properly applying modifiers -54, -55, -56 and -58. It's Not a Complication,It's 'More Extensive' Not every return to the operating room during the global period of a previous procedure is due to complications as indicated by modifier -78 (Return to the operating room for a related procedure during the postoperative period). In such cases, the subsequent procedure may be an extension of the first, but not included in the global package. CPT defines three occasions on which this may occur:

1) The surgeon prospectively plans the subsequent procedure at the time of the original procedure (staged)

2) The subsequent procedure/service is more extensive than the original procedure

3) The subsequent procedure/service is for therapy following a diagnostic surgical procedure. When any of these conditions are met, the surgeon may report the subsequent procedure or service by appending modifier -58 (Staged or related procedure or service by the same physician during the postoperative period) to the appropriate CPT code(s), says Linda Laghab, CPC, coding department manager for Pediatric Management Group at Children's Hospital, Los Angeles. In each case, the subsequent procedure or service is either related to the underlying problem/diagnosis that prompted the initial surgery or anticipated at the time of the initial surgery. The patient's condition, rather than the results of a previous surgery, dictates the need for additional procedures. Do not use modifier -58 for surgical complications or unexpected postoperative findings that arise from the initial surgery and necessitate subsequent procedures (modifier -78 is appropriate in these cases). Most commonly, you will use modifier -58 to indicate a staged procedure (that is, the procedure requires more than one operative session to complete), says Susan Callaway, CPC, CCS-P, an independent coding specialist and educator in North August, S.C. For instance, a patient undergoes surgery to remove a lesion from the base of the skull. Following surgery, the physician performs secondary repair of the dura to arrest cerebrospinal fluid loss. The surgeon performs the approach, lesion removal and primary closure (61580-61598 and 61600-61616, as appropriate) during a single, extended operative session. The secondary repair, planned prospectively at the time of the first session, occurs several days later. You would report this subsequent session with 61618 (Secondary repair of dura for CSF leak, anterior, middle or posterior cranial fossa following surgery of the skull base ...) with modifier -58 appended to indicate a staged procedure. In a second example, the surgeon [...]