# Neurosurgery



## ckirkp1 (Jun 7, 2010)

Can someone please help me. I have 2 neurosurgeon doctors (in the same speciality) that did a transsphenoidal resection of pituitary macroadenoma. One doctor did the transsphenoidal approach and closure. The other doctor removed the tumor. How can I code this??? The only code I can come up with is the 61548. But I don't think I can use this code with a modifier 62 if they are from the same speciality. Any help is appreciated. Thanks!!!


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## RebeccaWoodward* (Jun 8, 2010)

It almost sounds like an assistant surgery (80).  Without the specifics of the op note, have you ruled out 62165?


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## ckirkp1 (Jun 8, 2010)

*Thanks for your help!!!*

Thanks for the code the more I read the code description the more it fits the op note. So I plan to use that code. But as far as using for both neurosurgeons I don't know what I should do. According to the op report it has the surgeon and co-surgeon listed on the op report and they are both in the same field. So should I put a modifier 62 if they are in the same speciality?  Thanks for your help.


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## RebeccaWoodward* (Jun 8, 2010)

I have never reported 62 for the same specialty.  In my opinion, it would be hard to justify medical necessity for reporting modifier 62 since the surgeons are of the same specialty.  There would be a difference if reimbursement.  Are these neurosurgeons within the same group?  


If two surgeons (each in a *different* specialty) are required to perform a specific procedure, each surgeon bills for the procedure with a modifier “-62.” Co-surgery also refers to surgical procedures involving two surgeons performing the parts of the procedure simultaneously, i.e., heart transplant or bilateral knee replacements. Documentation of the medical necessity for two surgeons is required for certain services identified in the MFSDB.

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

40.8

I would check with the carrier in question.  It's possible that they will allow modifier 62...


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## Janet H. Deen (Jun 8, 2010)

Neurosurgery Coding Alert OCT 1999 addresses this scenario, do you have access?


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## RebeccaWoodward* (Jun 8, 2010)

Which volume/number?


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## RebeccaWoodward* (Jun 8, 2010)

BCBS of NC's policy...(example)

_Co-Surgeons are defined as two or more surgeons, *usually* from different specialties, where the participation of both surgeons is necessary in performing a specific operative procedure. This may be necessary due to the
complex nature of the procedure(s) and/or the patient’s condition. *Co-Surgeons may also be of the same specialty*, or may be of different specialties operating on separate body systems. Co-Surgery is always performed during the same operative session. Co-Surgeons may also be referred to as a Surgical Team._

Even though I've never had a situation when the same specialty billed as co-surgeons, the concept does exist. Be cautious with Medicare though...check with your local carrier.


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## ckirkp1 (Jun 9, 2010)

I'm going to submit it with the modifier and see what happens. I will give an update on if the insurance will pay or not. Thanks for the information and the help. I appreciate it!!!


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## FTessaBartels (Jun 23, 2010)

*Separate operative notes*

They did each dictate their own operative notes, I hope.  You will need them for the appeal.  Not to worry, I've had this type of scenario before; it's unusual but not unheard of. A cover letter and clearly documented separate operative notes got us paid. 

Hope that helps.

F Tessa Bartels, CPC, CEMC


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