Oncology & Hematology Coding Alert

But check the fee schedule before adding -62 or -80 to your claim Surgical oncology involves all sorts of procedures that are difficult to perform - limb conservation, sentinel node biopsies, radiofrequency ablation - and hard to code. We've got the skinny on accurately reporting multiple surgeons and those inevitable trips back to the surgeon for complications. Cooperate on Coding -62 Scenario: Your surgical oncologist performs a bilateral pelvic lymph node dissection and omentectomy on a patient with ovarian epithelial cancer. During the same operation, a general surgeon performs a total abdominal hysterectomy.
 
What to do: To qualify as co-surgeons, two surgeons must perform "distinct components" of a single identifiable CPT procedure, according to AMA guidelines. The two surgeons may be from the same or differing specialties, adds Elaine Evers, ART, CCS, CPC, with the MD Anderson Cancer Center division of surgery in Houston.
 
In this case, the surgical oncologist and the general surgeon did perform distinct components of the surgery during a single procedure, 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]), so each surgeon should report 58210 and each surgeon should append modifier -62 (Two surgeons).
  
Never: What you should definitely not do is allow the general surgeon to report a separate hysterectomy without lymph node excision while you separately code the lymph node excision for your surgical oncologist.
 
Such "fragmenting" would likely result in denied claims for both surgeons and could yield fraud allegations.
 
Tip: You can also use -62 when the distinct component is implied, Evers says. Example: Append -62 when the thoracic team dissects blood vessels to facilitate tumor resection by the urology team.
 
Smart: Before assigning -62, always check the Medicare database to be sure you can report this modifier with your CPT code, Evers says. Read "Find the fee schedule" on the following page to learn how to use the online database.

Remember -80 for Assistant Watch for: If your surgeon only acts as a "second pair of hands" in the operating room, assisting the primary surgeon, append modifier -80 (Assistant surgeon). An assistant surgeon does not have to provide his own operative notes, but you should be aware that payment is much less for an assistant surgeon than for a co-surgeon.
 
Find the fee schedule: For Medicare patients, check the fee schedule database to determine if you may use modifier -80. (You'll find it online at www.cms.hhs.gov/
physicians/mpfsapp/step0.asp.) A "0" in the ASST SURG column means that you can't append -80 to that particular code, while a "1" means you may claim an assistant surgeon for the procedure. A "9" indicates that the concept of assistant surgeon does not [...]