Orthopedic Coding Alert

Co-surgery coding can be as tricky as the complex surgery that triggers it, but if you append modifier -62, both surgeons can recoup 62.5 percent of the procedure's fee. Medicare and CPT specify strict instructions for co-surgery billing, and if you don't coordinate the two physicians' claims carefully, one surgeon could lose his reimbursement entirely. First Get Permission Modifier -62 (Two surgeons) indicates to carriers that two surgeons' individual skills are required during the same surgical procedure. In such cases, each surgeon appends modifier -62 to the applicable CPT procedure 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.
 
Section 15044 of the Medicare Carriers Manual (MCM) specifies that co-surgeons share responsibility for a surgical procedure, each serving as a primary surgeon during some portion of the surgery. Both must be surgeons and are frequently - but not necessarily - of different specialties. The MCM further specifies that co-surgeons share pre- and postoperative responsibility for the patient.
 
Although two heads may be better than one, neither CPT nor CMS allows billing for co-surgeons in every situation. Surgeons must determine which of the following four scenarios they meet before reporting co-surgeries, according to Medicare Physician's Fee Schedule Database:
 
1. Procedures for which modifier -62 is allowable, but supporting documentation is required to establish medical necessity for two surgeons, regardless of specialty: This category includes some leg and knee surgeries, such as 27405-27447, various arm and elbow surgeries (24365-24435), and some replantations (20802-20838). Your documentation must show which special circumstances or skills required two surgeons to share responsibility. For example, the extraordinary duration of a trauma surgery may require that two surgeons work in shifts, allowing each to scrub out while the other continues the procedure. Or they may work simultaneously but perform distinct components of a procedure.
 
These procedures are identified with a "1" in column V (labeled "co-surg") of the Physician Fee Schedule. 2. Procedures for which modifier -62 is allowable as long as each surgeon is of a different specialty: Examples of such procedures include arthrodesis 22532-22632 and pelvic fracture treatment 27215-27218.
These procedures are identified with a "2" in column V of the fee schedule database. 3. Procedures for which modifier -62 is never allowable: Such procedures are identified by a "0" in column V of the fee schedule database and include finger amputation codes 26910-26952 and hip x-ray injection codes 27093-27095, among others. 4. Procedures for which the concept of co-surgeons does not apply, and for which modifier -62 is therefore inappropriate: These procedures are noted by a "9" in column V of the fee schedule database. Such procedures are relatively rare and include [...]