Gastroenterology Coding Alert

Question: Our office had no idea that we could use modifier 62 (Two surgeons) when coding for some PEG tube placements. What are some other procedures we may report with modifier 62, and what should we keep in mind when considering the modifier?

Michigan Subscriber

Answer: In a gastro office, you would most likely use modifier 62 when coding for a PEG tube placement, which you should report with 43246 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with directed placement of percutaneous gastrostomy tube).

Make sure you answer these three questions before using modifier 62:

1. Does each provider have his own notes? When surgeons act as co-surgeons, they cannot share the same documentation.

Each physician should provide a note detailing what portion of the procedure he performed, how much work was involved, and how long the procedure took.

2. Does the gastro note the general surgeon in his documentation? Make sure that both -- not just one -- of the gastroenterologists involved in the co-surgery identify the other as a co-surgeon.

Both physicians must submit claims for the same procedure, and both physicians must use modifier 62 on their claims.

3. Are the gastro's and surgeon's diagnosis codes and procedure codes identical? Co-surgeons need to report the same diagnosis code(s) and CPT code(s). You should confirm with the other physician's office that both claims have the same codes before submitting a claim with modifier 62.

Because co-surgery claims are often the victims of intense scrutiny, each physician must diligently detail both the work he performed and the work the other physician performed.

Good idea: If you want to go that extra mile with your modifier 62 claim, you should consider submitting a letter to the insurer explaining the reason for two surgeons.