Urology Coding Alert

A quick scan through these guidelines guarantees you'll choose the right modifier for every case.

When your urologist works with another surgeon during a procedure, such as a urinary diversion, you will need to use a modifier to show the split work. But which one applies: modifier 62 or modifier 80? You'll find your answer every time by following these steps.

Choose 62 for Co-Surgeons

When two surgeons work together to perform distinct portions of a procedure, which CPT identifies with a single reportable code, attach modifier 62 (Two surgeons), says Christy Shanley, CPC, billing manager for the University of California, Irvine department of urology. According to the AMA, "each surgeon should report his/her distinct operative work by adding the modifier 62 to the single definitive procedure code." In short, modifier 62 applies for only one primary procedure and any of its related add-on codes for each surgeon.

How it works: Check the Medicare physician fee schedule database to confirm that the procedure you wish to report qualifies for modifier 62, Shanley advises. Otherwise, you cannot code and bill as co-surgeons for that procedure. To be eligible for payment, make sure that your procedure codes have either a Medicare co-surgery indicator of "1" or "2."

When your urologist works with another surgeon, 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 equally between the two surgeons reporting the procedure, so each surgeon receives 62.5 percent of the standard fee.

Warning: You must supply documentation to establish medical necessity for two surgeons. You should present which circumstances in the procedure require special skills or expertise by two surgeons sharing a responsibility. Add 80 for Assistant Surgeon You should append modifier 80 (Assistant surgeon) when your urologist is the second physician in the operating room and acts as an "extra pair of hands" to assist the primary surgeon, Shanley says.

According to Medicare guidelines, "an assistant at surgery must actively assist when a physician performs a Medicarecovered surgical procedure. This necessarily entails that the assistant be involved in the actual performance of the procedure, not simply in other, ancillary services." Unfortunately, payers will not reimburse for assistants at surgery in all cases, regardless of the modifiers you append to the claim. As a first step, you must determine if the code for which you wish to report an assistant at surgery is eligible for assistant-at-surgery payment.

Here's how: The easiest way to check if a code is eligible for assistant-at-surgery payment is to check the "ASST SURG" column of the Medicare Physician Fee Schedule Relative Value File:

If you find a "2" in this column for the code you wish to report, Medicare will reimburse for an assistant at surgery.

Likewise, if you find a "0," Medicare will allow payment for an assistant at surgery as long as you submit supporting documentation to establish medical necessity.

In contrast, a "1" in the "ASST SURG" column tells you that Medicare will never pay for an assistant at surgery.

A "9" indicates that the concept of assisted surgery does not apply.

Know When to Skip the Modifier

Medicare guidelines dictate that when surgeons of different specialties perform distinct, sequential, and unrelated procedures, each surgeon should bill his procedure separately, at full fee, with no modifier.

Pointer: "I commonly bill out an 80 modifier for the assist, which is usually our physician assistant on staff," says Samantha Daily, billing specialist for Urologic Consultants in Portland, Ore. If an outside provider is used, then I confer with the other biller/coder in the other provider's office ... I always use the operative report as my guide for billing out an assist."