Neurosurgery Coding Alert

Question: How should I code for the transsphenoidal resection of pituitary adenoma when the otolaryngologist consultant performs the approach and transnasal transseptal sphenoidotomy and the neurosurgeon performs the resection of the adenoma?

Texas Subscriber

Answer: In this case, the otolaryngologist and neurosurgeon are working as cosurgeons (that is, the two surgeons are performing separate portions of the same surgery). Therefore, according to CMS and CPTguidelines, each surgeon should bill for the procedure with modifier -62 (Two surgeons) appended. The procedure you describe would be reported 61548 (Hypophysectomy or excision of pituitary tumor, transnasal or transseptal approach, nonstereotactic). You must support medical necessity for two surgeons in the accompanying documentation.

Note: If the surgeon harvests and places a fat graft, he or she may report 20926 (Tissue grafts, other [e.g., paratenon, fat, dermis]) in addition to 61548-62.

When you append modifier -62, the carrier should reimburse each surgeon 62.5 percent of the rate normally allowed for the procedure. For instance, the Physician Fee Schedule assigns 38.9 relative value units (RVUs) to 61548, for an average payment of $1,408 for Medicare carriers. When you add modifier -62 to 61548, each surgeon participating in the procedure receives an average payment of $880 (0.625 x $1,408). Medicare does not consider which surgeon performed the more "difficult" portion of the surgery. Payment is equal.

Each surgeon must bill independently and prepare his or her own operative report submitted with the claim. The two surgeons should "coordinate" their coding. If, for instance, one surgeon neglects to append modifier -62, the carrier may pay at full profile but deny the cosurgeon's claim.

Some payers will automatically reject modifier -62 claims if the two surgeons are of the same specialty. National Medicare policy, however, does not limit payment of claims to surgeons of different specialties, so you may be able to appeal a denial.