Use Modifier -62 to Get Payment for Co-Surgeons
Published on Fri Sep 01, 2000
Two surgeons often participate in complicated ob/gyn surgeries. But their degree of participation, the complexity of the procedure and the way the procedure is coded impact reimbursement. Modifier -62 (two surgeons) results in optimum reimbursement when more than one surgeon is involved, but physicians and coders must understand its proper use and apply it only in genuine cases of dual surgery.
Make Sure Its Co-surgery
Per CPT 2000, modifier -62 is intended for use only when two surgeons work together as primary surgeons performing distinct part(s) of a single reportable procedure. If the second surgeon acts as a first assistant, rather than a co-surgeon, modifier -80 (assistant surgeon) is used. In all cases, modifier -62 is to be used only by a surgeon, not by a physician assistant (PA), nurse practitioner (NP) or other trained surgical staff person. Although a literal reading of modifier -80 indicates that it is only for use with physicians, some commercial carriers will accept the -80 modifier when a PA, certified surgical assistant (CSA) or NP serves as first assistant in surgery, but Medicare requires the -AS (physician assistant, nurse practitioner or clinical nurse specialist services for assistant at surgery) modifier in such situations.
It is my understanding, that co-surgery is when two surgeons split one reportable CPT code, says Katie McClure, RHIA, surgical coder for Southeastern Gynecologic Oncology, a six-physician practice in Atlanta. Each surgeon performs his or her part of the procedure as a primary surgeon. This differs from a surgery where one surgeon performs the surgery, and the other is an assistant. McClure says that for her practices specialty, co-surgeries most often occur with 58210 (radical abdominal hysterectomy, with bilateral total pelvic lymphadenectomy and para-aortic lymph node sampling [biopsy], with or without removal of tube[s], with or without removal of ovary[s]). A gyn will perform the hysterectomy portion as primary surgeon, and our gyn oncologist specialist will perform the removal of nodes portion as a primary. This scenario differs from a mere primary surgeon, assistant relationship. For this to be billed as 58210-80, the scenario would have been the gyn doing the entire surgery as primary, with our doctor only serving in an assistant capacity, she explains.
McClure has run into problems billing for co-surgeons. My experience has been that many people have a misunderstanding of when to use the co-surgeons concept when coding and billing. This is especially a problem if the second surgeon is from a different practice, and his or her office refuses to correctly code the surgery as a co-surgery. This is a problem because, using the example of 58210, one practice wanted to incorrectly code their portion separately as 58150 (total abdominal hysterectomy [corpus and cervix], [...]
