Ob-Gyn Coding Alert

Occasionally, ob/gyn surgery requires two surgeons during the same session to perform a difficult procedure or more than one procedure. How can you accurately code for these services? Using the correct codes and modifiers is essential for assuring reimbursement, says Barbara J. Cobuzzi, MBA, CPC, a physician reimbursement specialist and president of Cash Flow Solutions, Inc., in Lakewood, NJ.

Distinct Expertise Required, Same Procedure

Consider a case in which two surgeons are needed for the operation, and each surgeons specialty, talent or expertise is distinct and essential from the others. A woman has been diagnosed with a gynecologic malignancy and needs a total hysterectomy along with removal of the ovaries and bladder and ureteral transplantations. Rather than perform the surgery alone, a gynecologist decides the services of a urologist are also needed. Both surgeons perform the procedure, bringing their expertise to the specialty-specific aspects of the case. The gyn focuses on the hysterectomy and the urologist on the bladder removal and ureteral transplantation.

According to Cobuzzi, what is important in this example is that each surgeons distinct talent is needed to complete the surgery. One surgeon is not assisting the other. Therefore, each specialist will report the procedure 58240 (pelvic exenteration for gynecologic malignancy), along with the -62 modifier. The CPT explains modifier -62 as follows: When two surgeons work together as primary surgeons performing distinct part(s) of a single reportable procedure, each surgeon should report his/her distinct operative work by adding the modifier -62 to the single definitive procedure code.

The rationale behind the -62 modifier is that the main surgeon requires more than just another surgeons assistance for the primary procedure. Both talents are needed. There-fore, the primary procedure must be shared equally between both surgeons. Both will report the surgery, and both the gynecologist and urologist must dictate an operative report that describes, in detail, their parts in the operation. In addition, both should document the other surgeons part, as well as mentioning that the other surgeon also will be dictating a report. Some consultants say that each surgeon should bill 125 percent of his or her fee and expect to be reimbursed about 50 percent of that. Others say each surgeon did not perform more than he or she usually would (should they have performed the procedure separately); in fact, each does slightly less work. In this view, each physician should bill his or her regular fee; the insurance company will generally pay up to 125 percent of the allowable in co-surgery situations and then split this amount in half, giving 66 percent to each surgeon.

The use of modifier -62 will not generally make an allowance for an additional surgeon to act as an assistant because of [...]