General Surgery Coding Alert

Question: How should I code an abdominal aortic aneurysm (AAA) repair with more than one physician? Should I bill the appropriate code and append modifier -62?

Illinois Subscriber
 
Answer: You can report many AAA services with modifier -62 (Two surgeons) if two physicians act as cosurgeons during the procedure.
 
Section 15044 of the Medicare Carriers Manual specifies that each cosurgeon must serve as the primary surgeon during some part of the operation and that each must perform a distinct portion of a single reportable procedure. Although the surgeons operate on the same patient during the same operative session, they in fact work independently of one another.
 
Medicare Memorandum AB-01-08, dated Aug. 3, 2001, announced a change to the cosurgery status of the AAA endovascular codes. Previously, these codes had a status of "0," which means that Medicare did not cover cosurgery. However, the "0" status did not accurately reflect the extensive nature of AAA procedures. For example, one surgeon may place the prosthesis percutaneously via one artery while a second surgeon places a docking limb via the femoral artery on the right side.
 
For example, if an interventional radiologist performs the endograft, a surgeon may need to be on standby in case the endograft fails and an open procedure is required.
 
In such cases, many carriers take into account that both the surgeon and the radiologist performed an endograft-to-open procedure: 34830, Open repair of infrarenal aortic aneurysm or dissection, plus repair of associated arterial trauma, following unsuccessful endovascular repair; tube prosthesis; 34831 ...; aorto-bi-iliac prosthesis; and 34832 ...; aorto-bifemoral prosthesis.
 
As a result of such concerns, Medicare changed the status of these codes to "2," which means you can report cosurgery by appending modifier -62 to the appropriate procedure code (34830-34832).
 
As with all cosurgeon claims, each surgeon should dictate a separate operative report, and each should report the same procedure code with modifier -62 attached.

 - Technical and coding advice for You Be the Coder and Reader Questions provided by Marcella Bucknam, CPC, CCS, CPC-H, CCS-P, HIM program coordinator at Clarkson College in Omaha, Neb.