Radiology Coding Alert

When you append modifier 62 to a claim, you're indicating that your radiologist will be splitting the fee with another physician. That means you should master how to determine when modifier 62 (Two surgeons) applies to the code you wish to report, says Stephanie Collins, CPC, healthcare consultant with Gates, Moore & Company in Atlanta. For Medicare patients, the solution is as simple as checking the fee schedule.

To confirm that the procedure you wish to report qualifies for modifier 62, turn to the Medicare physician fee schedule (MPFS) database. To be eligible for payment, make sure that the physicians are from different specialties and your 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.

1: 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, say experts. You should present which circumstances in the procedure require special skills or expertise by two surgeons sharing a responsibility.

2: 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. Code 34802 (Endovascular repair of infrarenal abdominal aortic aneurysm or dissection; using modular bifurcated prosthesis [one docking limb]), for example, has a "2" in the co-surgery column.

Impact: Medicare coverage dictates a pricing of 125 percent of the allowable, which means each physician receives 62.5 percent.

Resources: You can search the Medicare physician fee schedule online at www.cms.hhs.gov/pfslookup. And if

you download the 2010 files available at www.cms.hhs.gov/PhysicianFeeSched/PFSRVF/list.asp, you can find modifier indicator definitions in the file "RVUPUF10."