Neurosurgery Coding Alert

Coding can become tricky when two surgeons work together during the same surgery. Medicare and CPT specify strict instructions for co-surgery billing and, depending on the procedure(s) involved, documentation requirements to justify billing for two surgeons can vary. Proper use of modifiers and thorough record-keeping go a long way to guarantee proper and timely payment.First Things First:Is It Allowable?Modifier -62 (Two surgeons) indicates that the individual skills of two surgeons are required during the same surgical procedure. In such cases, each surgeon codes independently of the other, with modifier -62 appended to the applicable CPT procedure code (s).Section 15044 of the Medicare Carriers Manual (MCM) further specifies that co-surgeons share responsibility for a surgical procedure, each serving as a primary surgeon during some portion of the surgery. Both must be surgeons, and are frequently but not necessarily of different specialties. The MCM further specifies that co-surgeons share pre- and postoperative responsibility for the patient.For instance, a neurosurgeon and otolaryngologist may work side-by-side during the approach"" portion of a skull base surgery (e.g., 61590, Infratemporal pre-auricular approach to middle cranial fossa [para-pharyngeal space, infratemporal and midline skull base, nasopharynx], with or without disarticulation of the mandible, including parotidectomy, craniotomy, decompression and/or mobilization of the facial nerve and/or petrous carotid artery). In this case, each surgeon reports 61590-62.Although two heads are generally better than one, neither CPT nor CMS allows billing for co-surgeons in every situation. According to the Physician Fee Schedule, surgical procedures fall into one of four categories with respect to co-surgeons:1. Procedure for which modifier -62 is allowed but supporting documentation is required to establish medical necessity for two surgeons, regardless of specialty: This category includes some craniectomies (e.g, 61526 and 61530), craniotomy 61533-61543 and most skull base surgery approach codes (61580, 61582-61598). The documentation should show what special circumstances or skills required the surgeons to share responsibility for the patient. For example, the extraordinary duration of some skull base surgeries may require that two surgeons work in shifts, allowing each to scrub out while the other continues the procedure. Or they may work simultaneously but perform distinct components of a procedure.These procedures are identified with a ""1"" in column U (labeled ""co-surg"") of the Physician Fee Schedule.2. Procedures for which modifier -62 is allowed as long as each surgeon is of a different specialty: Two neurosurgeons working together cannot report modifier -62 for these codes. Examples of such procedures include laminotomy/laminectomy codes 63001-63048 and diskectomy 63075-63078.These procedures are identified with a ""2"" in column U of the fee schedule.3. Procedures for which modifier -62 is never allowed: Such procedures are identified by a ""0"" in column U of the fee schedule and include endovascular therapy (61624-61626) and stereotactic [...]