Cardiology Coding Alert

Question: How should I code an abdominal aortic aneurysm with more than one physician? Should I bill the appropriate code and append modifier -62?

Illinois Subscriber

Answer: You can report many AAA services with modifier -62 (Two surgeons) if two physicians act as co-surgeons to the procedure. According to CPT, you should use modifier -62 when "two surgeons work together as primary surgeons performing distinct part(s) of a procedure ..."

Section 15044 of the Medicare Carriers Manual specifies that each cosurgeon must serve as the primary surgeon during some part of the operation and that each perform a distinct portion of a single reportable procedure (if each surgeon performs a separately reportable procedure, even during the same operative session, you cannot report them as cosurgeons). Although the surgeons operate on the same patient during the same operative session, they in fact work independently of one another.

Medicare Memorandum AB-01-08, dated Aug. 3, 2001, announced that the final update of the 2001 Medicare Physician Fee Schedule database included a change to the cosurgery status of the AAA endovascular codes. 

Previously, these codes had a status of "0," which means that Medicare did not cover cosurgery. However, the "0" status did not accurately reflect the extensive and delicate nature of AAA procedures. For example, one surgeon may place the prosthesis percutaneously via one artery while a second surgeon places a docking limb via the femoral artery on the right side.

If a cardiologist performs the endograft, a surgeon may need to be on standby in case it fails and an open procedure is required.

In such cases, many carriers take into account that both the surgeon and the cardiologist performed an endograft-to-open procedure (34830, Open repair of infrarenal aortic aneurysm or dissection, plus repair of associated arterial trauma, following unsuccessful endovascular repair; tube prosthesis; 34831, Open repair of infrarenal aortic aneurysm or dissection, plus repair of associated arterial trauma, following unsuccessful endovascular repair; aorto-bi-iliac prosthesis; and 34832, Open repair of infrarenal aortic aneurysm of dissection, plus repair of associated arterial trauma, following unsuccessful endovascular repair; aorto-bifemoral prosthesis).

As a result of such concerns, Medicare changed the status of these codes to "2," which means that you can report cosurgery by appending modifier -62 to the appropriate procedure code (34830-34832). 

However, as with all claims involving modifier -62, each surgeon should dictate a separate operative report using the same procedure code with modifier -62 attached.

Medicare should pay 125 percent of the fee schedule rate for the procedure performed, split evenly between the two surgeons.