Podiatry Coding & Billing Alert

Hint: When you append modifier 62, each physician should identify the other as a co-surgeon.

The podiatrist worked together with another surgeon to perform one procedure. In this case, you must carefully read your podiatrist’s medical documentation to see if you can append modifier 62 (Two surgeons). However, you must follow very specific rules when it comes to the documentation requirements if you want to appropriately append modifier 62.

Read on to learn more.

Append Modifier 62 in This Case

When two surgeons cooperate to perform a surgery within the same body cavity and with a single goal, each of them applies his own expertise to achieve that single goal. At the same time, they assist and complement each other.

To bill for co-surgery, both surgeons must bill using the same CPT^® code(s) and append modifier 62. In other words, you should append modifier 62 when two surgeons work together to complete a procedure described by a single CPT^® procedure code.

“When two surgeons work together as primary surgeons performing distinct part(s) of a procedure, each surgeon should report his/her distinct operative work by adding modifier 62 to the procedure code and any associate add-on code(s) for that procedure as long as both surgeons continue to work together as primary surgeons,” according to CPT^®. “Each surgeon should report the co-surgery once using the same procedure code.”

In short, modifier 62 applies for only one primary procedure and its related add-on codes for each surgeon.

Each Physician Must Identify as Co-Surgeon

When you append modifier 62, each physician should identify the other as a co-surgeon. Make sure the other physician is billing with modifier 62. A lot of confusion can arise when physicians from different practices are reporting the same procedure.

You may find yourself in a situation where one physician may report the other physician’s work as that of an assistant surgeon, in which case the claims would not correspond. This means a denial will hit your desk. One surgeon cannot simply indicate the other as the co-surgeon. Both physicians must submit claims for the same procedure, both with modifier 62.

You can accomplish this with a simple courtesy call to the other physician’s billing or coding department, experts say.

Submit Separate Operative Notes

To bill a service as co-surgeons, each physician should document her own operative notes. When surgeons are acting as “co-surgeons,” it is implied that they are each performing a distinct part of the procedure which means they can’t “share” the same documentation.

Each physician should provide a note detailing what portion of the procedure she performed, how much work was involved, and how long the procedure took. Including a brief explanation of the need for co-surgeons will help to avoid denials and reimbursement delays.

However, if a singular operative report is used for both physicians (same practice/same Tax ID number with different UPIN number), both physicians must confirm and sign off on this operative report, and each specific service provided must be spelled out and identified who provided what service in a descriptive explanation. The word “we” shouldn’t be used. Attaching specific physicians’ names to the specific procedures is recommended.

Each Physician Reports Same Dx Codes

When using modifier 62, each physician must link the same diagnosis code to the common procedure code. Though this requirement may seem obvious, if two physicians serve as co-surgeons to perform one procedure, the diagnosis code(s) they link to the CPT^® code should be the same — and it almost always will be. Before submitting a claim with modifier 62, someone in the practice must confirm that both claims have the same ICD-10 code(s).

Keep Eye On Co-Surgery Indicators

When you append modifier 62 (Two surgeons), you must first confirm that the procedure you wish to report qualifies. You can find this information in the Medicare physician fee schedule (MPFS) database. To be eligible for payment, make sure that the procedure codes have a Medicare co-surgery indicator of either “1” or “2.” If not, your physicians cannot code and bill as co-surgeons for that procedure.

If you find a code carries a co-surgery indicator of “1,” you must supply documentation to establish medical necessity for two surgeons. Only when you establish medical necessity clearly will a payer consider additional reimbursement. You should present which circumstances in the procedure require special skills or expertise by two surgeons sharing a responsibility.

A “2” in the co-surgery column indicator means that you may append modifier 62 as long as each of the operating surgeons is of a different specialty.

Coding Example: Put It All Together

Two physicians, a podiatrist and an orthopedic surgeon, cooperate to fix a displaced, open fracture of the body of the patient’s right calcaneus.

The podiatrist performs open surgical treatment of a calcaneal fracture. He uses screws to fix the fracture. The orthopedic surgeon then obtains a bone graft from the iliac crest, through a separate incision.

Both the podiatrist and the orthopedic surgeon identify each other as a co-surgeon. Each provider documents his own operative notes, detailing the portion of the procedure he performed, how much work was involved, and how long the procedure took. Each provider also gave a brief explanation of why co-surgeons were needed.

Both the podiatrist and the orthopedic surgeon should report 28420 (Open treatment of calcaneal fracture, includes internal fixation, when performed; with primary iliac or other autogenous bone graft (includes obtaining graft)), with modifier 62 appended.

Notice that 28420 ha a co-surgery indicator of, “1.” Also, in their documentation, each provider will link 28420 to the same ICD-10 code, which in this case is S92.011B (Displaced fracture of body of right calcaneus, initial encounter for open fracture).