Oncology & Hematology Coding Alert

Solution: Don't search out multiple codes for this one procedure - 45126 (Pelvic exenteration for colorectal malignancy, with proctectomy [with or without colostomy], with removal of bladder and ureteral transplantations, and/or hysterectomy, or cervicectomy, with or without removal of tube[s], with or without removal of ovary[s], or any combination thereof) will cover all of your bases. And append modifier 62 (Two surgeons) to each surgeon's claim when their documentation meets the requirements below:
 
Does each surgeon have his own notes? When surgeons are acting as co-surgeons, they cannot share the same documentation, unless they are following a payer's specific guidelines. Best bet: Each physician should provide a note detailing what portion of the procedure he performed, how much work was involved, and how long the procedure took. Documentation should also include medical necessity for having two surgeons on the case, says Elaine Evers, ART, CCS, CPC, with the division of surgery at the MD Anderson Cancer Center in Houston.
 
Alternative: For some payers, like Pennsylvania's HGSA Medicare, one operative report will suffice if the documentation clearly identifies the procedure performed
by each surgeon and each surgeon's role. For HGSA, if you don't submit the report(s), expect a denial (www.hgsa.com/professionals/refman/chapter22.shtml).
 
Does each physician mention the co-surgeon in his documentation? Make sure that both - not just one - of the physicians involved in the co-surgery identify the other as a co-surgeon, Evers says.
  
Both physicians must submit claims for the same procedure, and both physicians must use modifier 62 on their claims, or the one without the modifier will be the only one paid.
 
Are the surgeons' diagnosis and procedure codes identical? Co-surgeons need to report the same diagnosis code(s) and CPT code(s). You would be wise to have someone confirm that both claims have the same codes before submitting a claim with 62. Because co-surgery claims are often the victims of intense scrutiny, each physician must diligently detail both the work he performed and the work the other physician performed.
 
Good idea: Go the extra mile with your 62 claim. Submit a letter to the insurer explaining the reason for two surgeons.