Successful claims require modifier -62 and physician-to-physician cooperation
When reporting co-surgeries, you should make sure the procedures qualify for co-surgery by appending the appropriate modifier and by supplying adequate documentation to support all claims. First Step: Check the Physician Fee Schedule Before filing a co-surgery claim, you should check with the Physician Fee Schedule database to be sure the procedure you wish to report qualifies for use with modifier -62 (Two surgeons). If modifier -62 doesn't apply to a particular code, two surgeons cannot claim themselves as co-surgeons for that procedure.
Don't waste your effort: "Medicare won't pay for co-surgeries with all codes or will only pay for co-surgeries with a given code under certain circumstances," says Stephanie Collins, CPC, healthcare consultant with Gates, Moore & Company in Atlanta. "To avoid mistakes that will lead to a rejected claim, you should know up-front whether and when modifier -62 applies to the code(s) you wish to report."
When determining if modifier -62 applies, CMS divides all CPT codes into four categories. To find the status of a given code, look to column "V" -- labeled "CO-SURG" -- of the fee schedule database.
If you find a "1" in column V: You may append modifier -62, but you must supply documentation to establish medical necessity for two surgeons. Specifically, your documentation must show which special circumstances or skills required two surgeons to share responsibility. For example, the extraordinary duration of a trauma surgery may require that two surgeons work in shifts, allowing each to scrub out while the other continues the procedure. Or the surgeons may work simultaneously but perform distinct components of a procedure.
If you find a "2" in column V: You may append modifier -62 as long as each of the operating surgeons is of a different specialty. This can also occur during trauma surgery, because a patient may require several simultaneous procedures requiring the skill of different surgeons.
If you find a "0" in column V: Medicare will not allow modifier -62 for that procedure, and you may not bill for co-surgeons.
If you find a "9" in column V: The concept of co-surgery does not apply. You should not report modifier -62 for these procedures.
Note: You may download the Physician Fee Schedule database from the CMS Web site (
www.cms.gov). Use the "search" function to locate "2004 Physician Fee Schedule." Second Step: Append Modifier -62 You've checked the fee schedule database. Now be sure to append modifier -62 to the appropriate code(s).
Remember: You should only apply modifier -62 for procedures in which the operating surgeons worked as co-surgeons, Collins says. To qualify as co-surgeons, the operating surgeons must share responsibility for the surgical procedure, with each serving as a primary surgeon [...]
