General Surgery Coding Alert

Question: We are under the impression that modifier -62 (two surgeons) should be used by surgeons of different specialties performing surgery on the same patient at the same time and -80 (assistant surgeon) should be used when one surgeon assists another surgeon of the same specialty. Should we be using modifier -62 when one surgeon assists another in, for example, a vascular bypass graft?

Valerie Link
Harrisonburg, Va.

Answer: Specialty is not as important in this scenario as function, although most carriers do require and expect that the surgeons will be of different specialties (check with your carrier for its specific interpretation), says Susan Callaway-Stradley, CPC, CCS-P, a coding and reimbursement specialist in North Augusta, S.C.

To use modifier -62, each physician must perform a distinct portion of the procedure as the primary surgeon and dictate his portion of the procedure in an op report. In some instances, medical documentation also would be required to justify the use of two surgeons.

For instance, a fem-pop bypass, done bilaterally (on a patient with underlying medical conditions that require that time under anesthesia be limited) could be coded 35556-50-62 (bypass graft, with vein; femoral-popliteal; bilateral procedure; two surgeons). This procedure likely would involve two physicians of the same specialty. Each physician would use the same code and submit documentation of their distinct services (one on left, one on right) with documentation of the patients underlying conditions prompting the need for two surgeons.

Alternatively, a general surgeon might participate with a urologist to perform a pelvic exenteration for a malignancy. Each physician would prepare a separate operative report for the portion of the surgery he performed and submit the claim using the same code, 58240-62 (pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube[s], with or without removal of ovary[s], with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof; two surgeons).

In this scenario, it usually would not be required that the documentation be submitted with the claim. If the situation truly required an assistant at surgery, where throughout the case only one physician acts as a primary surgeon and the other acts as an assistant, the -62 modifier would not be appropriate. The surgeon would submit (as in the first example) 35556-50, and the assistant would submit 35556-50-80 (bypass graft, with vein; femoral-popliteal; bilateral procedure; assistant physician).