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 apply.
 
You may also find a "2," as in the following example: Your surgical oncologist assists in a quadrantectomy with axillary lymphadenectomy (19162, Mastectomy, partial [e.g., lumpectomy, tylectomy, quadrantectomy, segment- ectomy]; with axillary lymphadenectomy). You find 19162 in the fee schedule database, and the "ASST SURG" column contains a "2" indicator. This means that you may append modifier -80 to the code to describe the presence of an assisting physician in the operating room, but only if each has a different specialty. If your surgeon doesn't qualify - don't report the procedure. Only the main surgeon may code in this case.
 
Protect yourself: Check with your payer to determine its specific reporting guidelines for surgical modifiers.

Post -78 and -79 After Surgery
 
Just knowing how to code the surgery isn't enough - you also need to be an expert at choosing modifiers for services after the operation. To decide between modifiers   -78 and -79 for a procedure during the postoperative period, the most important question you must ask yourself is, "Would the second surgery have been necessary if the first surgery hadn't occurred?"
 
When the second surgery is required because of circumstances arising from the initial surgery, you should turn to -78 (Return to the operating room for a related procedure during the postoperative period).
 
Apply -78 when:
 1. the surgeon must undertake the subsequent surgery for reasons related to an initial surgery (for example, complications)
 2. the subsequent surgery occurs during the global period of the initial surgery
 3. the subsequent surgery requires a return to the operating room (OR).

Caution: If the physician planned to perform the procedure in two or more sessions, you should look to -58 (Staged or related procedure or service by the same physician during the postoperative period).
 
Don't miss: If one surgeon must perform a separate evaluation and a distinct, unrelated surgery - including all follow-up - for an unanticipated medical condition during the global period of a previous procedure, you should append -79 (Unrelated procedure or service by the same physician during the postoperative period) to the subsequent procedural code(s), says Laureen Jandroep, OTR, CPC, CCS-P, CPC-H, CCS, director and senior instructor for CRN Institute, an online coding certification training center based in Absecon, N.J.
 
In other words, you should apply -79 when:
 1. the surgeon must undertake the subsequent surgery for conditions unrelated to the initial surgery
 2. the subsequent surgery occurs during the global period of the initial surgery.

Helpful: The descriptor may not mention it, but most clinical examples you'll find specifically include a return to the OR.
 
Note: Remember these tips! Next month's issue will quiz you on surgical modifiers and the documentation you need to sail through the claims review.