Gastroenterology Coding Alert

Question: The December issue of Gastroenterology Coding Alert featured an example of a PEG tube placement reported with modifier -62 (Two surgeons). Our office had no idea that modifier -62 could be used when coding for some PEG placements. What are some other procedures we may report with modifier -62,    and what should coders keep in mind when considering the modifier?

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

There are other procedures that may call for a pair of surgeons, and thus modifier -62, but these are generally true surgical procedures and not endoscopic procedures. Some of these procedures include:

 Enterectomy (44120, Enterectomy, resection of small intestine; single resection and anastomosis)
 Colectomy (44140, Colectomy, partial; with anastomosis)
 Hernia repair (Codes 49491, Repair, initial inguinal hernia, preterm infant [less than 37 weeks gestation at birth], performed from birth up to 50 weeks postconception age, with or without hydro-celectomy; reducible, through 49566, Repair recurrent incisional or ventral hernia; incarcerated or strangulated).

No matter which procedure you're reporting, make sure you answer these questions before using modifier -62:
 Does each surgeon have his own notes? When surgeons are acting 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.  Does each gastro note the co-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.  Are each gastro's diagnosis codes and procedure codes identical? Co-surgeons need to report the same diagnosis code(s) and CPT code(s). It would be wise to have someone confirm 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.  - Clinical and coding expertise for You Be the Coder and Reader Questions provided by Michael Weinstein, MD, a gastroenterologist in Washington, D.C., and former member of the CPT advisory panel; and Linda Parks, MA, CPC, CCP, coding and billing coordinator for [...]