Otolaryngology Coding Alert

Question: The otolaryngologist did the approach for an orthopedist who performed a spinal osteotomy with neck exploration. The otolaryngologist reported his role in the session as 21899. Shouldnt this be coded 22220-62?

California Subscriber
 
 Answer: Yes. CPT and Medicare indicate that this approach to spinal surgery (22220-62, osteotomy of spine, including diskectomy, anterior approach, single vertebral segment; cervical; two surgeons) is usually included in the definitive procedure.
 
Billing for it separately (21899, unlisted procedure, neck or thorax) could be considered fraud.
 
Only skull-base surgery codes are exempt from this guideline.
 
In this case, the otolaryngologist is accessing the spine for the orthopedist. For a spinal osteotomy, the orthopedist would provide his or her own access. An orthopedist may call in a specialist to handle the approach, especially if the patient has an altered surgical field due to excessive scarring as a result of prior surgery.
 
Both the otolaryngologist and the orthopedist should report 22220 with modifier -62 appended. It may be necessary to coordinate billing with the orthopedists office to ensure both surgeons report the same code with the same modifier. The surgeons should dictate separate operative reports, which state that the physician was a co-surgeon (not an assistant) for the procedure in question.
 
Medicare pays both surgeons who report a procedure with modifier -62 a total of 125 percent of the normal fee schedule amount (62.5 percent of the fee schedule amount per surgeon).  In this case, 125 percent of the RVUs for code 22220 would be split between the two surgeons. Its important to bill the procedure at 125 percent of the normal rate, otherwise the carrier may split the smaller amount billed (whether 100 percent, 62.5 percent or some other amount).