# Modifier 62 - the reimbursement breakdown



## nyyankees (Oct 2, 2009)

Does anyone know the breakdown of Modifier 62 (i.e. what is the reimbursement breakdown, surgeons assisting each other from separate practices, etc.) One of my Dr's office managers asked me and I never had to answer this type of question so I want to make sure I have it corect. Thanks.


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## RebeccaWoodward* (Oct 2, 2009)

For co-surgeons (modifier 62), the fee schedule amount applicable to the payment for each co-surgeon is 62.5 percent of the global surgery fee schedule amount.

http://www.cms.hhs.gov/manuals/downloads/clm104c12.pdf

Section 40.8 B


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## FTessaBartels (Oct 2, 2009)

*Assist is NOT modifier -62*

However, if one surgeon is acting as an assistant to another sugeon, then the assistant surgeon uses the -80 (or -82) modifier.  Only the primary surgeon needs to dictate an operative note, in which the assistant surgeon is identified and a description of the assistance given is included.

If they are truly co-surgeons (each performing a distinct portion of a complete procedure), they they each append the -62 modifier on the CPC code (both should be using the exact same code), and they each much dictate their own operative report.

Hope that helps.

F Tessa Bartels, CPC, CEMC


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## nyyankees (Oct 2, 2009)

FTessaBartels said:


> However, if one surgeon is acting as an assistant to another sugeon, then the assistant surgeon uses the -80 (or -82) modifier.  Only the primary surgeon needs to dictate an operative note, in which the assistant surgeon is identified and a description of the assistance given is included.
> 
> If they are truly co-surgeons (each performing a distinct portion of a complete procedure), they they each append the -62 modifier on the CPC code (both should be using the exact same code), and they each much dictate their own operative report.
> 
> ...



Tessa-
Thanks. What is the reimbursement on a surgeon that is only an assistant? Are there any guidelines that need to be followed when billing out an assistant surgery?


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## FTessaBartels (Oct 5, 2009)

*Assistant Surgeon reimbursement*

Reimbursement varies with your payer ... typically 18-20% of the allowable for the primary surgeon.

The primary surgeon dictates the operative report, listing the assistant surgeon (could be another surgeon, a PA or NP) and some description of the assistant's role in the surgery.  If you are in a teaching hospital and dealing with a government payer (Medicare or Medicaid), you must have a statement to the effect that "no qualified resident was available and so Dr X assisted."

If the two surgeons are NOT in the same practice and don't have access to each other's operative reports you will have to coordinate with the other surgeon's staff to get a copy of the note(s) and to ensure that they are in agreement with the coding (especially if you are using -62 co-surgeon modifier).

Hope that helps.

F Tessa Bartels, CPC, CEMC


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## LLovett (Oct 5, 2009)

For Medicare it is 16% if the assistant is another MD/DO and 10.4% if the assistant is a NP/PA.

Laura, CPC, CEMC


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## nyyankees (Oct 5, 2009)

Thank you both!! Funny there was an article in the Coding Edge magazine this month. Read it over the weekend which really helped.


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