Otolaryngology Coding Alert

Reserve co-surgery appendage for when ENT shares procedure

You should limit modifier -62 use to operations in which the otolaryngologist performs part of the same procedure with the other surgeon.

Modifier -62's descriptor - "two surgeons" - can be deceptively simple. Just because an operation involves two surgeons doesn't mean modifier -62 is appropriate. Let these expert-provided tips guide you in coding the following case study:

Modifier -62 or Not? You Decide

Procedure: One otolaryngologist performs a total pharyngolaryngectomy with modified radical neck dissection. Another otolaryngologist (same practice) performs a complex wound reconstruction that involves a tubed, radial forearm flap with microvascular anastomosis as well as a skin graft to the arm where the surgeon took the flap from.

Possible codes: "I believe this is probably a co-surgery with code 31395-62," says Robin Trahon, CPC, coding specialist at Otolaryngology Group in Dedham, Mass.

Problem: The reconstruction that the otolaryngologist performed is much more radical and difficult than 31395 (Pharyngolaryngectomy, with radical neck dissection; with reconstruction) describes. "Would the reconstruction be so complex as to warrant not billing this as co-surgery, but billing separately for 15758 (Free fascial flap with microvascular anastomosis) and 15100 (Split graft, trunk, arms, legs; first 100 sq cm or less, or 1 percent of body area of infants and children [except 15050])?" Trahon asks.

Co-Surgery Applies to Single Code

First, you should remember that modifier -62 refers to a single procedure (same CPT codes and add-on codes). Just because two physicians perform surgery on the same patient during the same operative session doesn't mean they were co-surgeons.

Better way: "The general rule is if two surgeons are required to perform a specific procedure, each surgeon bills for the procedure with modifier -62 plus any associated add-on codes performed during a procedure in which the two surgeons continue to work together as primary surgeons," says Jean Ryan, LPN, CPC, consultant and application specialist at QuadraMed in Fargo, N.D.

For instance, you would use modifier -62 when a neurosurgeon and an otolaryngologist perform neuroendoscopy with excision of a pituitary tumor, says Danielle Demaio-Deangelis, CPC, director of practice operations at Thomas Jefferson University Department of Otolaryngology/Head and Neck Surgery in Philadelphia. The otolaryngologist could perform the approach while the neurosurgeon excises the tumor. Because both surgeons perform portions of the same procedure (62165, Neuroendoscopy, intracranial; with excision of pituitary tumor, transcranial or trans-sphenoidal approach), modifier -62 appropriately describes the otolaryngologist and neurosurgeon's roles as co-surgeons.

To avoid denials, the otolaryngologist and neurosurgeon must report the same CPT (62165-62) and ICD-9 codes (such as 194.3, Malignant neoplasm of pituitary gland and craniopharyngeal duct). Each co-surgeon charges 125 percent of the global surgery fee schedule amount and is paid half or 62.5 percent of the global surgery amount.

Payment remains the same even if one surgeon did more work. "It's up to the surgeons to equalize that between themselves," Ryan says.

Code Duel Procedures Individually

In contrast, when an otolaryngologist and another physician perform separately defined procedures, you should bill your otolaryngologist's work. When surgeons perform two unrelated procedures, "each physician should bill for and be paid the full global fee for the procedure he/she performed," instructs HGSAdministrators Part B (Pennsylvania) Reference Manual.

Real-world coding: In the case study, otolaryngologist A performs a total pharyngolaryngectomy with modified radical neck dissection. Otolaryngologist B does a complex wound reconstruction that involves a tubed, radial forearm flap with microvascular anastomosis as well as a skin graft to the arm where the surgeon took the flap from.

"Code 31395 includes a myocutaneous major muscle flap, which is not the same as a free fascial flap with microvascular anastomosis," says Julie Keene, CPC, an otolaryngology coding and reimbursement specialist at University ENT Specialists in Cincinnati.

Each procedure has its own CPT-defined code. "So in this case, each physician should bill for the procedures they each performed," Keene says. You would report otolaryngologist A's portion as 31390 (... without reconstruction) and otolaryngologist B's as 15758 (flap) and 15100 (graft).