Neurology & Pain Management Coding Alert

Neurosurgeons often work with physicians of other specialties, particularly orthopedic, general and thoracic surgeons. For example, in complex spine procedures,
a neurosurgeon frequently will perform the surgery with other specialities or a general surgeon. Modifier -62 (two surgeons) is used in these situations to optimize reimbursement.

Modifier -62 is used to append a CPT code that is shared by two surgeons. Medicare and most private carriers allow an additional 25 percenta total of 125 percentreimbursement for a procedure when modifier -62 is used. This is then split between the two co-surgeons62.5 percent to each. The 125 percent payment can be split in different proportions, but only if both co-surgeons make such a request in writing to Medicare or the insurance carrier. Be prepared to wait longer for the payment to be processed if such a request is made.

Recall Changes for Modifier -62

Coders should remember the substantial changes in the use of the -62 modifier this year that affect their billing practices. Before 1990, if you used modifier -62 you could not be an assistant (denoted by modifier -80) at the same time. Therefore, you could not use the -80 modifier, says Gregory J. Przybylski, MD, an assistant professor of neurosurgery at Thomas Jefferson University in Philadelphia and a CPT editorial panel advisor to the American Medical Association (AMA), representing the Congress of Neurological Surgeons.

Now you can only use modifier -62 on a single code, he says. But you can use -80 and -62 in the same session. That was the tradeoff, says Przybylski.

Another change effective this year: The requirement that co-surgeons using the -62 modifier be in different specialties was dropped. So, now you can be in the same specialty and use modifier -62, although thats unlikely. It would be very difficult to prove the medical necessity for co-surgeons if both are neurosurgeons.

Under this arrangement, neurosurgeons stand to be reimbursed more since they are doing an equal split only on the highest relative value code.

There is definitely some confusion about modifier
-62, says Kim Pollock, RN, MBA, a consultant with Karen Zupko and Associates, a practice management consulting firm based in Chicago. Pollock specializes in neurosurgery coding.

Probably the most frequent misconception is that modifier -62 can be used for an assistant surgeon. Its abused this way. It should be used only when two surgeons are doing different parts of an operation, as opposed to modifier -80, where one surgeon is just assisting the other.

The same surgeon can claim a -62 on one procedure and bill an -80 on all the others. What is not appropriate is to bill modifiers -62 and -80 plus the primary surgeons code in the same session. You cant play three roles. The correct way to do that is that you are a co-surgeon on one procedure, and the other co-surgeon assumes primary surgeon responsibility.

Examples Show How to Use Modifiers

Example 1: A neurosurgeon performs a vertebral corpectomy in the thoracic region, with a thoracic surgeon doing the thoracotomy and closure. Each would code 63085-62. For subsequent procedures in the operation, however, the neurosurgeon should file for full reimbursement while the thoracic surgeon files an -80 modifier appended to the procedure code as an assistant if he remains in the operating room and is involved in those procedures.

Example 2: A neurosurgeon and general surgeon perform an anterior lumbar interbody fusion with threaded cages and iliac autograft and would use the following codes:

22558-62, anterior lumbar arthrodesis

22851, placement of single/paired threaded cages

20936, harvest cancellous autograft

This case assumes that the neurosurgeon and general surgeon worked together on 22558 and that the general surgeon assisted on 22851 and 20936. In that case modifier -62 would apply only to 22558 for the general surgeon, and the neurosurgeon would code without any modifier and for full reimbursement for the other two procedures. The assistant surgeon files with modifier -80 on codes 22851 and 20936.

Example 3: The general surgeon is an assistant surgeon on all three procedures. In that case the neurosurgeon files for full reimbursement on each, and the assistant uses modifier -80 on those same procedures. As an assistant, the general surgeon would receive 16 percent of the fee schedule value of each procedure from Medicare.

Five Tips for Using Modifier -62

1. Both physicians should dictate their own operative notes and identify each other as co-surgeons. Of course, both should use the same CPT code appended with the -62 modifier.

2. The 1999 rules effectively eliminate the possibility of paying a third surgeon as an assistant in most cases. Although it isnt against the rules, most carriers will pay for only one assistant in an operation. There might be exceptions, but expect a very critical look by payers at documentation and medical necessity before theyll pay for three surgeons in most operations.

3. Modifier -62 is to be used by doctors only. Only MDs and DOs can use modifiers -62 and -80. Physician assistants, RNs or other medical professionals assisting in an operation should use modifier -AS.

4. Both co-surgeons should submit their own HCFA 1500 forms. They also need to provide their own docu-
mentation, noting the specific procedures they performed.

5. Physicians must have their own personal identification numbers (PIN) to bill as co-surgeons. Neurosurgery doesnt recognize subspecialties. So if two physicians have the same tax ID numbers (because they are from the same practice), they will be considered one person from a payer standpoint and wont be able to use the -62 modifier, says Przybylski.

Note: Three co-surgeons would use modifier -66, the indicator for team surgery. However, it is unlikely that neurosurgeons could ever justify that modifier. I do not recommend the use of that code, says Przybylski. The purpose of that code is for really major, complicated, multispecialty operations such as transplants. Its not designed for neurosurgery procedures.