Neurosurgery Coding Alert

Question: How should I code when a general surgeon performs the surgical exposure for a spinal fusion? A neurosurgeon performs the arthrodesis itself.


Indiana Subscriber

Answer: Access and closure are an inherent part of any surgical procedure, including arthrodesis. You cannot -separate out- the exposure for coding purposes or for separate payment.

Because the general surgeon and neurosurgeon are working together to provide a single identifiable procedure (for instance, 22558, Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace [other than for decompression]; lumbar), you may gain reimbursement for both surgeons by proper application of modifier 62 (Two surgeons)

To qualify as co-surgeons, the operating surgeons must share responsibility for the surgical procedure, with each serving as a primary surgeon during some portion of the procedure, according to chapter 20, section 40.8.B of the Internet Only Manual (IOM).

To report a co-surgery claim, each surgeon would report the appropriate primary procedure code, with modifier 62 appended. For example, for your claim:

- the general surgeon would report 22558-62 for the approach
- the neurosurgeon would also report 22558-62 for the fusion.

To ensure your documentation supports the claim, follow these four simple rules:

1. Each physician should document his own op notes. Because co-surgeons each perform a distinct part of the procedure, they can't share documentation. Each physician should provide a note detailing what portion of the procedure he performed, how much work was involved and how long the procedure took.

2. Each physician should identify the other as a co-surgeon. And both surgeons must submit claims for the same procedure with modifier 62 appended.

3. The co-surgeons should link the same diagnosis to the common procedure code. Before submitting a claim with modifier 62, coders from each practice should confirm that both claims have the same ICD-9 codes.

4. Each physician should submit his own claim with his own documentation. Because claims for co-surgeons of the same specialty can come under additional scrutiny, each physician should diligently note both the work he performed and that of the other physician.

How payment works: Medicare and most other payers reimburse procedures coded with modifier 62 at 125 percent of the regular fee schedule amount. The payer divides this between the two surgeons reporting the procedure, so each surgeon receives 62.5 percent of the standard fee.

Technical and coding guidance for You Be the Coder and Reader Questions provided by Gregory Przybylski, MD, director of neurosurgery at the New Jersey Neuroscience Institute, JFK Medical Center in Edison.