Neurosurgery Coding Alert

Question: When two or more surgeons work together in a procedure, do they quality as co-surgeons?

New York Subscriber

Answer: Not all surgeons who work together in a procedure qualify for being a co-surgeon and not all procedures that involve team work may qualify for payment for the services of assistants.

Make sure to append modifier 62 (Two surgeons: ….) when the operating surgeons work as co-surgeons during a procedure such that each serves as a primary surgeon during some part of the procedure. You should make sure that individual skills of two surgeons were independently required in the same procedure. Also, the co-surgeons are responsible to share the preoperative and postoperative care for the patient. However, each may not always be from a different specialty.  Both co-surgeons must dictate a separate operative note specifying the portions of the procedure that each performed.  CMS has payment rules that identify which CPT® codes the co-surgery modifier may be applied to and whether documentation of medical necessity is required.

Examples of co-surgery procedures are below:

• When your neurosurgeon does an anterior lumbar interbody fusion, he works with a vascular surgeon for obtaining the surgical exposure. Each surgeon in this case has distinct roles and both can append modifier 62.
• You may read that two surgeons worked in shifts for a surgery that lasted unusually long. In this case, your documents should support that two surgeons worked simultaneously but performed distinct steps in sequence during the procedure. You can report the procedure code with modifier 62.

Your surgeon may do an anterior cervical discectomy and fusion (ACDF) where an ENT surgeon may assist with the approach. You would code 22551 (Arthrodesis, anterior interbody, including disc space preparation, discectomy, osteophytectomy and decompression of spinal cord and/or nerve roots; cervical below C2) with modifier 62 and +22552 (Arthrodesis, anterior interbody, including disc space  preparation, discectomy, osteophytectomy and decompression of spinal cord and/or nerve roots; cervical below C2, each additional interspace [List separately in addition to code for separate procedure]) with modifier 62 for the add-on code for the additional level.