Urology Coding Alert

Question: I have a situation where my doctor and another doctor (not associated with our group) performed surgery together. My doctor did the sling (57288) and after he was done the other doctor did a rectocele repair (45560). The dictation done by my doctor clearly states: The vaginal incision was closed using 2-0 Vicryl stitch. The rectocele repair will be dictated by Dr. XYZ. Does this meet the standard for modifier 62 as two primary surgeons performing distinct part(s) of a procedure, or should I use modifier 80 as they each performed their own separate procedures?

Alaska Subscriber

Answer: In your clinical scenario each physician would bill and code for the procedure he performed.

So your physician would report 57288 (Sling operation for stress incontinence [e.g., fascia or synthetic]) and the other physician would report 45560 (Repair of rectocele [separate procedure]).

If the physicians did in fact assist each other, then you will bill the assisted procedure with modifier 80 (Assistant surgeon) for private carriers.

Keep in mind: Medicare will not pay an assistants fee if each physician did a major procedure during the same encounter as in this case, so for Medicare patients you should just report the code for the procedure your physician performed with no modifier attached.

Pitfall: Do not be tempted to use modifier 62 (Two surgeons) in the case. This modifier would not be appropriate since each physician performed separate procedures with separate CPT codes. You would only report co-surgeons (using modifier 62) if the surgeons worked together on the same procedure, each performing a portion of the total procedure, and both report the same CPT code. In such a case, each physician would document, in separate operative reports, the part or portion of the total procedure he performed.