Neurosurgery Coding Alert

When coding claims for spinal arthrodesis via anterior approach, pay special attention to whether a second surgeon works with your surgeon to provide the approach and closure portions of the procedure. If so, you-ll have to take some additional steps to gain fair payment.

When two surgeons work together to perform distinct portions of a procedure CPT identifies with a single reportable code, you-ll need to access modifier 62 (Two surgeons). Often, in neurosurgery, you-ll see claims of this type during anterior approach arthrodesis.

"Typically a general or thoracic surgeon will provide surgical access and closure," notes Nancy Reading, RN, BS, CPC, director of educational services for the American Academy of Professional Coders. The neurosurgeon will then perform the arthrodesis, along with related bone graft and instrumentation procedures.

For example: A thoracic surgeon and neurosurgeon work together during arthrodesis for interspaces T6-T7, T7-T8 and T8-T9 using an anterior approach for interbody technique. Additionally, the neurosurgeon packs the interspaces with morselized allograft and places anterior instrumentation with attachment points at T6, T7, T8 and T9.

In this case, both the general surgeon and neurosurgeon will report 22556 (Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace [other than for decompression], thoracic) and append modifier 62 for the initial interspace (T6-T7) and +22585-62 x 2 for the additional interspaces (T7-T8 and T8-T9).

Only the neurosurgeon will report the bone graft (+20930, Allograft for spine surgery only; morselized [list separately in addition to code for primary procedure]) and instrumentation placement (+22846, Anterior instrumentation; 4 to 7 vertebral segments [list separately in addition to code for primary procedure]) because the general surgeon did not assist in these procedures. (Note, in addition, that CPT instructions prohibit modifier 62 with spinal bone graft and instrumentation procedures).

When reporting co-surgeries, you should work closely with the other operating surgeon's staff to ensure that each practice gets its fair share of the reimbursement.

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

To ensure that both physicians receive proper payment correctly, follow four guidelines:

1. Each physician should document his own operative notes, detailing what portion of the procedure he performed, how much work was involved and how long the procedure took.

2. Each surgeon should identify the other as co-surgeon.

3. The co-surgeons should link the same diagnosis to the common procedure code.

4. Each physician should submit his own claim with his own documentation, and diligently note both the work he performed and that of the other physician.

If claims are filed incorrectly, "usually whichever surgeon gets his claim in first gets paid -- and the other does not," Reading warns.

"My experience for a successful outcome has been to collect both operative notes and CMS forms and send them in together," Reading concludes.