# Primary & Assistant Surgeon



## CoderChick24 (Jan 28, 2010)

Does anyone know of a reference for whether or not a physician can be both a primary & assistant surgeon during the same operative session? 

For example, two docs of different spcialties are performing surgery on a patient. Can each one be the primary for the surgery related to their specialty and then be the assistant for the other doc of a different specialty? 

Any information anyone has would be appreciated!


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## FTessaBartels (Jan 29, 2010)

*Co Surgeons?*

Are you sure they aren't really co-surgeons?

More details of the scenario, please.  

F Tessa Bartels, CPC, CEMC


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## CoderChick24 (Jan 29, 2010)

Unfortunately, I don't have many details to give.   It's a general question, so there isn't much detail. I don't believe it is a co-surg situation, because they aren't both working as primary surgeons. One is assisting the other on the portion that isn't in their specialty. 


My understanding is that a physician can't be both a primary & assist in the same surgery, but I can't find documentation. Our Medicare carrier used to have something online, but it's no longer available.


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## LLovett (Jan 29, 2010)

This is an interesting concept. 

If the 2 surgeons are working on their own surgeries at the same time they could not be assisting each other.

If they are doing them at separate times they could be assisting each other. It would be complicated coding since they would both have global periods attached to them. Their assist claims would have to have the 80 and the 24 modifiers. Not sure how that would work out. This just sounds like a nightmare to get paid. Documentation would be a pain as well. 

I can't even think of a scenario where this would be the case. Generally when I have different surgeons involved they are not helping each other, they have their own PAs or residents assist them.

I used to have a breast surgeon that worked in concert a lot with a plastic surgeon. We never billed for them assisting each other, of course their notes didn't support that they did that.

Occasionally my cvt surgeons work with the vascular surgeons and the plastic surgeons, again they don't assist each other they just do their own thing.

It would be interesting to see this in a real world case.

Laura, CPC, CPMA, CEMC


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## FTessaBartels (Jan 29, 2010)

*Co-Surgeons*

This is a very interesting academic question.  But, I just cannot envision a scenario where this would happen.

I'm thinking of a recent case where the thoracic surgeon needed to resect a chest wall tumor and then plastic surgeon came in to do the reconstruction of the chest.  Some people might say these are two distinct procedures.   Each surgeon dictated his own operative note. Each surgeon was the "primary" surgeon for his own unique portion of the operative session procedure.   

But if you look at the description of Modifier 62 in Appendix A of the 2010 CPT (professional edition) you will see that this perfectly describes the scenario.  So, in this case both surgeons used CPT 19271 with -62 modifier. 

This is frequently also used with anterior spinal fusions. The general or thoracic surgeon will open the approach for the orthopaedic or neurosurgeon to perform the fusion.  But the code used is the fusion code with a -62 modifier. 

If you ever come up with a specific case, please post the scrubbed op.

It's good to exercise our brain cells!

F Tessa Bartels, CPC, CEMC


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