Neurosurgery Coding Alert

Question: Our neurosurgeon performs craniofacial surgeries with a plastic surgeon. The plastic surgeon bills 21175, while we report 61557-62 for our surgeon. The plastic surgeon says that he has no involvement in the craniotomy. Should we bill without modifier 62?

New Jersey Subscriber

Answer: In this case, yes, you should be billing without modifier 62 (Two surgeons).

Medicare guidelines dictate that when surgeons of different specialties perform distinct, sequential procedures as you describe, each surgeon should bill his procedure separately, at full fee, with no modifier.

Therefore, you should report 61557 (Craniotomy for craniosynostosis; bifrontal bone flap) alone, with no modifiers, for your surgeon's service.

The plastic surgeon would report 21175 (Reconstruction, bifrontal, superior-lateral orbital rims and lower forehead, advancement or alteration, with or without grafts [includes obtaining autografts]) separately -- again, with no modifiers -- for the reconstruction.