Ob-Gyn Coding Alert

Two scenarios illuminate when you should and shouldn't append modifier 62.

Ob-gyn coders rejoice: Medicare has changed the co-surgeon indicator for 57155 to a "2." This means co-surgeon reporting is permitted -- but do you know how to correctly report co-surgery claims? If you're not sure when to apply modifier 62 and what documentation your physician should provide, you could face a denial that's complicated to appeal.

Solution: Tackle these two scenarios -- one where the physicians assist each other and one where the physicians perform distinct parts of the procedure -- and discover when you should apply modifier 62.

Scenario 1: Both MDs Perform Same Procedure

Suppose a urologist and an ob-gyn perform a bladder suspension and a hysterectomy at the same surgical session.

Solution: Both physicians should report 58267 (Vaginal hysterectomy, for uterus 250 grams or less; with colpo-urethrocystopexy [Marshal-Marchetti-Krantz type, Pereyra type] with or without endoscopic control) or 58293 (Vaginal hysterectomy, for uterus greater than 250 grams; with colpo-urethrocystopexy [Marshall-Marchetti-Krantz type, Pereyra type] with or without endoscopic control).

You should report this claim as two surgeons (modifier 62). In other words, "each surgeon is going to code the main procedure with modifier 62," says Marcella Bucknam, CPC, CCS-P, CPC-H, CCS, CPC-P, charge capture manager for the University of Washington Physicians in Seattle.

Reason: If one specialist performs one part, or component, of a procedure, and another specialist is performing another part of the procedure, payers will consider them co-surgeons. This means the physicians should each report the same CPT^® code with modifier 62. Using modifier 62, each surgeon will receive 62.5 percent of the allotted fee for the service, unless the surgeons agree to a different split in advance, which they would communicate to the payer.

Scenario 2: Each MD Performs Distinct Services

But what if the services performed by the two specialists aren't represented in a single code?

If two surgeons are working on performing two distinct procedures during the same surgical session, you can't use modifier 62 and call the surgery a co-surgery because the physicians won't be reporting the same code. In this case, each physician should report the code for the service he provided, without a modifier.

Example: A patient undergoes a vaginal hysterectomy and a sling procedure. In this case, each surgeon should report a separate code(s) to represent his individual service(s).

The urologist would report 57288 (Sling operation for stress incontinence [e.g., fascia or synthetic]), and the gynecologist would report either 58260 (Vaginal hysterectomy, for uterus 250 grams or less) or 58262 (... with removal of tube[s], and/or ovary[s]). Modifier 62 no longer applies because the surgeons report two separate codes.

Upside: When two separate codes are used, each physician should receive the full fee allotted for the service he reports. But keep in mind that each physician must separately document their respective procedures, and each is responsible for postoperative care for the surgery they performed.

Caveat: You may need to include a modifier 52 (Reduced services) if both surgeons performed their distinct procedures through the same operative incision. For instance, the gyn surgeon could be performing a non-radical laparoscopic hysterectomy and due to a suspicion of cancer, a gyn oncologist comes in to do a laparoscopic sampling of nodes (38571, Laparoscopy, surgical; with bilateral total pelvic lymphadenectomy). In this case, the gyn surgeon has "opened" the patient and the gyn oncologist is present only for his procedure with the gyn surgeon closing. Per CPT^® establishing the surgical field and exploration are integral parts of every procedure and when not performed, the surgeon who did not open and close should append modifier 52.

Apply This Knowledge To 57155 News

So now that you have examined two scenarios, you can apply this knowledge to your 57155 (Insertion of uterine tandem and/or vaginal ovoids for clinical brachytherapy) claims.

For instance, suppose your ob-gyn and a radiation oncologist both perform the service described by 57155 on the same patient during the same surgical session. Both physicians should report 57155-62. Each surgeon will receive 62.5 percent of the allotted fee for the service (unless the surgeons agree to a different split in advance, which they would communicate to the payer).

Suppose your ob-gyn places the uterine tandem and/or vaginal oviods, while the radiation oncologist inserts the radiation capsules into the uterine tandem at the same time. Then you would report 57155 without modifier 62, and the radiation oncologist would report 77761 (ntracavitary radiation source application; simple) without modifier 62.