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Handy FAQs Test Your Modifier 62 Smarts

Published on Tue Mar 02, 2021

Make sure CPT® and ICD-10-CM codes match for both co-surgeons.

A new subscriber recently wrote in, asking about how to correctly use modifier 62 (Two surgeons). You may need to use this modifier if your cardiologist works together as a co-surgeon with another surgeon to perform one procedure. However, modifiers can be tricky. For example, modifier 62 comes with very specific rules.

Ask yourself the following questions to make sure you always append modifier 62 appropriately on your cardiology claims.

Only Append Modifier 62 in This Case

FAQ 1: How do I know if I can appropriately append modifier 62 to my cardiologist’s claim?

Answer: Check the medical documentation for several details. First, you must make sure that your cardiologist worked together with another surgeon and that they were both considered primary surgeons. This is very important because if your cardiologist was a co-surgeon, then you could append modifier 62. However, if your cardiologist was an assistant surgeon instead, you would look to other modifiers such as modifier 80 (Assistant surgeon), modifier 81 (Minimum assistant surgeon), and modifier 82 (Assistant surgeon [when qualified resident surgeon not available]).

Once you have confirmed that your cardiologist was indeed a primary co-surgeon, you must confirm that your cardiologist worked together with the other surgeon to complete a procedure described by a single CPT® procedure code.

“When two surgeons work together as primary surgeons performing distinct part(s) of a procedure, each surgeon should report his/her distinct operative work by adding modifier 62 to the procedure code and any associate add-on code(s) for that procedure as long as both surgeons continue to work together as primary surgeons,” according to CPT®. “Each surgeon should report the co-surgery once using the same procedure code.”

Identify Other Physician as Co-Surgeon

FAQ 2: My cardiologist performed a co-surgeon with another physician. My colleague was helping me code this claim. She said it would be a good idea to call the other physician’s billing department to ensure he is identifying our cardiologist as a co-surgeon and that he is billing the claim with modifier 62. Is this something I should do?

Answer: Yes. It would be a good idea to contact the other physician. One of the rules of modifier 62 specifies that each physician must identify the other as a co-surgeon. This is especially important as indicated previously because if, for example, your cardiologist reported the other physician’s work as a co-surgeon, but the other physician reported your cardiologist as an assistant surgeon, then your claim will be denied.

Also, you could check in with the other physician to double check that both your cardiologist and the other physician are reporting the same CPT® code to represent the procedure.

Make Sure Your Cardiologist Submits Own Operative Notes

FAQ 3: If my cardiologist acted as a co-surgeon with another physician, should my cardiologist submit his own operative notes?

Answer: Absolutely. When two physicians bill a service as co-surgeons, they should document their own operative notes. Since each physician performed a distinct part of the procedure, their documentation won’t be the same. Your cardiologist must include what portion of the procedure he performed, how much work was involved, and how long the procedure took. He can also explain why co-surgeons were needed for that particular procedure.

Don’t Forget to Match ICD-10-CM Codes

FAQ 4: If my cardiologist served as a co-surgeon with another physician and I called to double check we are submitting the same CPT® code, should I also ask about the ICD-10-CM codes?

Answer: Yes. Each physician must link the same diagnosis code to the common procedure code when using modifier 62. In other words, if two physicians are co-surgeons for one procedure, the diagnosis code they link to that CPT® code should be the same.

Double Check Co-Surgery Indicators

FAQ 5: I was reading about modifier 62, and I saw something about a co-surgery indicator. Can you explain to me what that is?

Answer: The co-surgery indicator is very important because it tells you whether the procedure you are reporting even qualifies for you to use modifier 62. You can use the Medicare physician fee schedule (MPFS) database to research this. You are looking for a Medicare co-surgery indicator of “1” or “2”. If the indicator is anything else, then you cannot bill for a co-surgeon.

If you find a code carries a co-surgery indicator of “1,” you must supply documentation to establish medical necessity for two surgeons. Only when you establish medical necessity clearly will a payer consider additional reimbursement. You should present which circumstances in the procedure require special skills or expertise by two surgeons sharing a responsibility.

A “2” in the co-surgery column indicator means that you may append modifier 62 as long as each of the operating surgeons is of a different specialty.

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