Neurosurgery Coding Alert

Question: If a neurosurgeon does the opening and closing exposure of a spine for an orthopedic surgeon performing a C3-C4 anterior cervical diskectomy (63075) with autologous iliac bone graft (20938, structural separate incision), should the neurosurgeon bill for all of the procedures that the orthopedist performs or only for the opening and closing?

Atlanta Subscriber

Answer: Catherine A. Brink, CMM, CPC, president of Healthcare Resources Management, Inc., a practice management and reimbursement consulting firm in Spring Lake, N.J., that consults with several neurology practices, says that according to CPT 2000, the -62 modifier (two surgeons) is to be used when two surgeons perform separate and distinct part(s) of a single reportable procedure. Each surgeon should report the co-surgery once using the same procedure code. If additional procedures (including add-on procedures) are performed during the same surgical session, these codes may be reported without the -62 modifier.

Eric Sandham, CPC, compliance educator for Central California Faculty Medical Group, a group practice and training facility associated with the University of California at San Francisco in Fresno, a coder who specializes in surgical and neurosurgical procedures, states that the neurosurgeon taking the lead for the opening and closing portions of the procedure supports the position that the neurosurgeon and the orthopedist were cosurgeons and that modifier -62 could be used on code 63075.

If the neurosurgeon assisted during the bone graft procedure then he or she could bill the 20938 with an -80 modifier (assistant surgeon) attached to it. A bone graft implies a fusion 22554. If the neurosurgeon performed a separate and distinct part of that procedure, he or she could bill the 22554 with the -62. Or, if the neurosurgeon assisted in the fusion, the -80 would be appropriate. To bill for cosurgeries, the neurosurgeon and his or her fellow surgeon must coordinate their billing so that if one bills a code with the -62 modifier, the other does as well.