General Surgery Coding Alert

Look to 'column X' to improve endoscope claims If you're wondering whether a particular surgery allows for a co- or assistant surgeon, look to Medicare's Physician fee schedule database for the answer.
 
Here's how to use the database to check on co-surgery status, and a great tip for reporting endoscopic procedures. Find Co-Surgeon Info in Column V Not every CPT code is eligible for reimbursement with a co-surgeon, and you can determine when you can use modifier -62 (Two surgeons) by looking to column "V" in the Excel version of the fee schedule database (see below for details on accessing the database). Recall that most payers reimburse an additional fee (generally 125 percent of the "usual" fee for the procedure, split evenly between the two surgeons) for modifier -62 claims, and therefore check these claims carefully, says Stephanie Collins, CPC, healthcare consultant with Gates, Moore & Company in Atlanta.

A "2" in column V next to the code you're investigating means that Medicare will pay for a co-surgeon for that procedure, as long as each surgeon is of a different specialty.

A "1" in column V indicates that Medicare may pay for a co-surgeon, but you must submit documentation to explain the medical necessity for a co-surgeon.

In contrast, a "0" means that Medicare will never pay two surgeons for the service, while a "9" means that the concept of co-surgery does not apply for that particular code (and therefore you should never apply modifier -62).

Example: Medicare considers most wound repairs to be relatively simple procedures and therefore not eligible for payment with a co-surgeon. For instance, the database assigns a "0" to column V for codes 12001-12006, meaning that you cannot be reimbursed with a co-surgeon with these procedures.
 
But for more extensive repairs, such as those described by 12007 (Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities [including hands and feet]; over 30.0 cm), CMS assigns a "1" to column V, meaning that Medicare may pay for a co-surgeon if documentation clearly explains why this is warranted.

Remember: To claim co-surgeons, each surgeon must perform a distinct portion of a single CPT procedure, and each surgeon must dictate and submit his own operative report for his portion of the surgery, says Barbara J. Cobuzzi, MBA, CPC, CPC-H, CHBME, president of Cash Flow Solutions Inc. in Brick, N.J. Follow Similar Criteria for Assistant Surgeons If you're looking to bill for an assistant surgeon with modifier -80 (Assistant at surgery), you can follow the same guidelines stipulated for co-surgeons, but look instead to column "U" of the fee schedule database.

A "2" in column U means that Medicare will pay for an assistant surgeon without further [...]