Practice Management Alert

Question: Our physicians often work with other surgeons in the operating room. We seem to get a lot of denials for the procedures, however. I think we're using the wrong modifiers. What modifiers do we need to append to our claims to ensure payment on co-surgeries? Arkansas Subscriber Answer: If your physician is acting as a co-surgeon with another physician, you should report the procedure code and append modifier 62 (Two surgeons). For your modifier 62 claim to succeed, both physicians must submit claims for the same procedure, using the same procedure code, and both physicians must use modifier 62. When reporting co-surgeries, you should work closely with the other operating surgeon's staff to ensure that each practice gets its fair share of the reimbursement. Medicare and most other payers reimburse procedures coded with modifier 62 at 125 percent of the regular fee schedule amount. The payer divides this between [...]