Neurosurgery Coding Alert

The May 2002 Neurosurgery Coding Alert erroneously reported that two surgeons working together during placement of spinal instrumentation as described by CPT 22840-22855 may append modifier -62 (Two surgeons) to the appropriate procedure code to describe the operation.

According to Medicare guidelines as defined by the 2002 Physician Fee Schedule, modifier -62 is legitimate with instrumentation codes 22840-22855, as indicated by a 1 or 2 listing in column U ("co-surg") of the fee schedule.

More important, however, CPT specifically forbids modifier -62 with 22840-22855, and most payers observe this restriction. Prior to CPT 2002, CPT did not restrict the use of modifier -62 with 22840-22855. For 2002 the extended descriptor for modifier -62 (see Appendix A of CPT) was changed to reflect that two surgeons are required to perform distinct portions of an operation to be classified as co-surgeons and, by definition, spinal instrumentation procedures do not lend themselves to such division of labor. CMS has yet to update the fee schedule to reflect this change in CPT policy.

Modifier -80 (Assistant surgeon) is appropriate for spinal instrumentation procedures (the fee schedule and CPT agree on this point), and therefore a second surgeon can receive reimbursement (albeit only 16 percent, rather than 62.5 percent, of the standard fee) for assisting by appending this modifier.