Neurosurgery Coding Alert

Pin down which physician performed each portion of co-surgery When two physicians work as co-surgeons on a complex procedure, your practice had better nail down the documentation perfectly -- and the other physician's practice had better follow the same rules. Otherwise, your 62.5 percent co-surgery payment could go up in smoke.

Sometimes the neurosurgeon will work alongside another surgeon and modifier 62 won't be necessary, but other times they will share a procedure that falls under the same CPT code. Check out the following op note, and then determine how you would code the claim before you review our experts- advice below. Preoperative diagnosis: Recurrent right cavernous sinus inferotemporal fossa maxillary region meningioma.

Procedure overview: The neurosurgeon performed an orbitocranial zygomatic approach and excised a tumor from the parasellar area, cavernous sinus, midline skull base, and the portion going into the maxillary sinus.
 
Op Report: Follow the Surgeon's Notes The pertinent details of the op note: The initial incision was made from the root of the zygoma extending across the temporal and frontal regions terminating just behind the hairline at the midline. The dura was stripped from the overlying bone, and using the Midas Rex drill, a right frontal temporal craniotomy flap was created and removed to allow elevation of the dura from the orbital roof. Osteotomy cuts were made in the standard orbital zygomatic fashion, allowing removal of the entire orbital zygomatic bar in one piece.

The otolaryngologist (ENT) then performed the orbital exenteration, increasing the room into the subfrontal and cavernous sinus region. The dura was elevated off the middle fossa floor, and the middle meningeal was identified and coagulated. The tumor was evident near the temporal tip region. The dura over the temporal tip was gradually opened, isolating the tumor away from the temporal lobe.

The tumor was gradually mobilized away from the sinus, allowing identification of the pituitary gland, which could be followed up to its stalk. These were protected with moistened Gelfoam and cottonoids, allowing further removal and mobilization of the sinus portion of the tumor and the portion going to the maxillary sinus, which wasamputated at this point with the CUSA, allowing complete mobilization and removal of the cavernous sinus temporal tip region of the tumor and the tumor that had been mobilized all in one block.
 
The ENT then proceeded with removal of the portion of the tumor into the maxillary sinus region. Following placement of drainage system, plates, screws and a fat graft, we proceeded with closure. Coding Advice: Clarify Who Performed Which Services Because the neurosurgeon dictated the op note in the passive voice (as most op reports are dictated), it does not specifically indicate which surgeon performed the orbitocranial zygomatic approach. But it appears as though [...]