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Urology Coding Alert

Reader Question:

Two Surgeons Starring in a Double Bill

Published on Fri Jan 02, 2004

Question: One of our urologists performed a sling operation and a sacrospinous ligament fixation for vaginal prolapse and stress incontinence (57288, 57282), and a gynecologist did a posterior repair (57250). Both surgeons are part of the same multispecialty practice but in different offices. Our compliance officer is telling the gynecologist's office we both need to charge the same code with modifier -62 and charge only one code. Is this correct?
      
Mississippi Subscriber
 
Answer: For the urologist, you should report 57288 (Sling operation for stress incontinence [e.g., fascia or synthetic]) for the sling procedure, and you should report 57282 (Sacrospinous ligament fixation for prolapse of vagina) for the sacrospinous ligament fixation.
 
For the gynecologist, report 57250 (Posterior colporrhaphy, repair of retrocele with or without perineor-rhaphy).
 
Clinically, these are all separate procedures. According to the National Correct Coding Initiative (NCCI), they are not bundled into each other or into the major procedure (52788). Carriers may consider these billable and payable services.
 
For non-Medicare patients, each physician could also act as a surgical assistant to the other. The urologist would bill 57250 for his repair appended with modifier -80 (Assistant surgeon).
 
The gynecologist would report 57288 for the sling operation, and he would report 57282 for the ligament repair and append modifier -80 as well.
 
Don't use modifier -62 (Two surgeons) for these particular procedures. The co-surgeon policy would not apply to these services in this clinical scenario.

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