October 28, 2021

Question:
Does the multiple procedure payment reduction apply for the same day anterior-posterior procedures when done through separate incisions? For example, if 22558 (anterior lumbar interbody fusion) and 22612 (posterolateral lumbar fusion) are performed, there is separate positioning and separate incisions so I don’t think the modifier 51 reduction should apply.

Answer:
Good question and we completely understand your viewpoint. We have to remember that payment for a surgical procedure also includes the associated pre- and post-operative care. For example, there is one preop H&P performed – not two. And, there is overlapping post-operative care because you don’t see the patient twice as many times when two stand-alone codes are reported.  The multiple procedure payment reduction applies to the secondary stand-alone procedure code(s) reported.

*This response is based on the best information available as of 10/28/21.