Neurosurgery Coding Alert

Always mind the co-surgery indicators.

Your neurosurgeon works together with another surgeon to perform one procedure. In this case, there is a certain modifier — modifier 62 (Two surgeons) that you can look to. But, there are certain rules you must follow when it comes to your neurosurgeon’s documentation requirements.

Read on to make sure you don’t drop the ball and you know how to appropriately append modifier 62.

Only Append Modifier 62 in This Case

Rule 1: When two surgeons cooperate to perform a surgery within the same body cavity and with a single goal, each of them applies his own expertise to achieve that single goal. At the same time, they assist and complement each other.

To bill for co-surgery, both surgeons must bill using the same CPT^® code(s) and append modifier 62. In other words, you should append modifier 62 when two surgeons work together to complete a procedure described by a single CPT^® procedure code.

“When two surgeons work together as primary surgeons performing distinct part(s) of a procedure, each surgeon should report his/her distinct operative work by adding modifier 62 to the procedure code and any associate add-on code(s) for that procedure as long as both surgeons continue to work together as primary surgeons,” according to CPT^®. “Each surgeon should report the co-surgery once using the same procedure code.”

In short, modifier 62 applies for only one primary procedure and its related add-on codes for each surgeon.

Each Physician Must Identify as Co-Surgeon

Rule 2: When you append modifier 62, each physician should identify the other as a co-surgeon. Make sure the other physician is billing with modifier 62. A lot of confusion can arise when physicians from different practices are reporting the same procedure.

You may find yourself in a situation where one physician may report the other physician’s work as that of an assistant surgeon, in which case the claims would not correspond. This means a denial will hit your desk. One surgeon cannot simply indicate the other as the co-surgeon. Both physicians must submit claims for the same procedure, both with modifier 62.

You can accomplish this with a simple courtesy call to the other physician’s billing or coding department, experts say.

Always Submit Separate Operative Notes

Rule 3: To bill a service as co-surgeons, each physician should document her own operative notes. When surgeons are acting as “co-surgeons,” it is implied that they are each performing a distinct part of the procedure which means they can’t “share” the same documentation.

Each physician should provide a note detailing what portion of the procedure she performed, how much work was involved, and how long the procedure took. Including a brief explanation of the need for co-surgeons will help to avoid denials and reimbursement delays.

Submit Claim Along With Documentation

Rule 4: To bill as co-surgeons, each physician must submit his own claim with his own documentation. Because claims for co-surgeons of the same specialty can come under scrutiny, each physician must diligently detail both the work he performed and the work the other physician performed.

Good advice: Many physicians submit a letter to the carrier detailing the reason for two surgeons.

Use Same Dx Codes

Rule 5: When using modifier 62, each physician must link the same diagnosis code to the common procedure code. Though this requirement may seem obvious, if two physicians serve as co-surgeons to perform one procedure, the diagnosis code(s) they link to the CPT^® code should be the same — and it almost always will be. Before submitting a claim with modifier 62, someone in the practice must confirm that both claims have the same ICD-10 code(s).

Mind the Co-Surgery Indicators

Rule 6: To confirm that the procedure you wish to report qualifies for modifier 62, turn to the Medicare physician fee schedule (MPFS) database. To be eligible for payment, make sure that the procedure codes have a Medicare co-surgery indicator of either “1” or “2.” If not, your physicians cannot code and bill as co-surgeons for that procedure.

1. If you find a code carries a co-surgery indicator of “1,” you must supply documentation to establish medical necessity for two surgeons. Only when you establish medical necessity clearly will a payer consider additional reimbursement. You should present which circumstances in the procedure require special skills or expertise by two surgeons sharing a responsibility.

2. A “2” in the co-surgery column indicator means that you may append modifier 62 as long as each of the operating surgeons is of a different specialty.

Putting It All Together

A general surgeon and neurosurgeon work together during arthrodesis for interspaces T6-T7, T7-T8 and T8-T9 using an anterior approach for interbody technique.

In this case, both the general surgeon and neurosurgeon will report 22556 (Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace [other than for decompression]; thoracic) and append modifier 62 for the initial interspace (T6- T7) and +22585-62 x 2 for the additional interspaces (T7-T8 and T8-T9).

Co-surgery indication alert: Code 22556 carries a “2” as its co-surgery indicator. Since a general surgeon and a neurosurgeon are of different specialties, you are permitted to use modifier 62 in this case.