Neurosurgery Coding Alert

Question: My neurosurgeon said he had a general surgeon to -assist- on an anterior lumbar interbody fusion (ALIF). When I got both op notes, however, the general surgeon did the anterior exposure for the ALIF, and then the neurosurgeon became active in the case. How should I report this?

Mississippi Subscriber

Answer: You should report 22558 (Arthrodesis, anterior interbody technique, including minimal diskectomy to prepare interspace [other than for decompression]; lumbar) for the procedure. Append modifier 62 (Two surgeons) to show that your neurosurgeon was a co-surgeon for the procedure.
 
Even though your physician said the other physician was assisting, he was actually a co-surgeon. Since each physician did a distinct component of the procedure and you have the two operative reports for each physician's portion of the procedure, modifier 62 is appropriate.
 
Tip: For a co-surgery claim to work, the two physicians must coordinate their billing strategies. This requires three steps:
 
- Because co-surgeons each perform a distinct part of a procedure identified by a single code, they can't share the same 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.
 
- Each physician should identify the other as a co-surgeon.
 
- The co-surgeons should link the same diagnosis to the common procedure code.