Orthopedic Coding Alert

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Question: One of our orthopedists performed a deep tissue excision of a patient's elbow, while one of our other physicians simultaneously performed a ganglion excision on the same patient's foot. Should we append modifier -62 (Two surgeons) to these codes, or should we just submit each code separately? Illinois Subscriber


Answer: Because your physicians are members of the same specialty and practice and were performing separate procedures, you should not append modifier -62 to either claim.

According to Section 4828 of the Medicare Carriers Manual (MCM), "If two surgeons (each in a different specialty) are required to perform a specific procedure, each surgeon bills for the procedure with a modifier -62 If surgeons of different specialties are each performing a different procedure (with specific CPT-4 codes), neither co-surgery nor multiple surgery rules apply (even if the procedures are performed through the same incision)."

Your practice should therefore report 24076 (Excision, tumor, soft tissue of upper arm or elbow area; deep [subfascial or intramuscular]) for the elbow excision and 28090 (Excision of lesion, tendon, tendon sheath, or capsule [including synovectomy] [e.g., cyst or ganglion]; foot) for the lesion excision. Because you performed these surgeries on separate anatomic sites for different diagnoses, you should not append any modifiers to these codes.