Gastroenterology Coding Alert

Question: Our gastroenterologist and a general surgeon performed surgery on a patient — the gastroenterologist performed the endoscopy to locate the correct position along the stomach wall for placement of a percutaneous endoscopic gastrostomy (PEG) tube. The general surgeon made an incision at the same position into the wall of the stomach and used a retention disk to put the PEG tube in place and secure it. Which code and/or modifier applies to this situation?

Idaho Subscriber

Answer: Each physician would bill using the same code: 43246 (Esophagogastroduodenoscopy, flexible, transoral; with directed placement of percutaneous gastrostomy tube). Both coders would also append modifier 62 (Two surgeons).

You should only report co-surgeons (using modifier 62) if two doctors are doing the same procedure, using the same procedure code, but each doing a component different from the other. Each surgeon must perform a distinct part of one procedure and must account for that operative work by appending modifier 62 to the code that best represents the service provided.

The rules about when you can and can’t use modifier 62 may vary by MAC or payer, so be sure to check your regulations and your individual payers to see if modifier 62 is right for your practice. CMS’ reimbursement policy is to pay 125 percent of the usual fee, split evenly (62.5 percent of usual fee) between the two physicians.