Recently Aetna recouped half of a procedure based on their multiple surgery rules. The surgeon performed an initial surgery one day. Due to the condition of the bowel (described as dusky), he delayed closure with a plan to explore the bowel the next day. He subsequently did that exploration and then did a delayed closure. I coded the 2nd procedure and appended it with a modifier 58. They paid the first procedure at 100% of the allowable. The procedure on the 2nd day was basically paid at 50% once they recouped their original payment. The only policy I can find on their website states that they will pay 50% of a 2nd procedure when done during the SAME SESSION. One rep stated that same session applies to the entire hospitalization, but I can find no policy that states that. Does anyone have some input on this? I appreciate it.
Multiple Surgery Rules Apply to Different day Surgeries?\
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