Neurosurgery Coding Alert

Question: I recently submitted a claim for two surgeons acting as co-surgeons during removal of anterior instrumentation. I appended modifier -62 to the claim, and each surgeon submitted his own operative report. The payer rejected the claim. Is this correct?

Oregon Subscriber

Answer: Assuming that you followed all the criteria for reporting modifier -62 (Two surgeons) accurately, the payer should have honored your claim. The payer's confusion is not unfounded, however.
 For 2003, CPT revised the instructional text accompanying the codes in the Spine (Vertebral Column) portion (22100-22855) to reflect new surgery guidelines. Specifically, previous versions of CPT have instructed, "Do not append modifier '-62' to spinal instrumentation codes 22840-22855." For 2003, these instructions have changed, stating, "Do not append modifier '-62' to spinal instrumentation codes 22840-22848 and 22850-22852."   

Therefore, you may report co-surgery if two surgeons work together as primary surgeons to reinsert a spinal fixation device (22849) or remove anterior instrumentation (22855). Possibly, your payer missed or has not yet adopted these changes. Resubmit your claim with a copy of the new CPT instructions, asking that the payer reconsider its decision.

 - Clinical and coding expertise for You Be the Coder and Reader Questions provided by Eric Sandham, CHC, CPC, compliance manager for Central California Faculty Medical Group, a group practice and training facility associated with the University of California at San Francisco in Fresno.