Secure Reimbursement for Two-Surgeon Procedures
Published on Wed Dec 01, 1999
To secure reimbursement for the variety of procedures that call for two surgeons to work on the same patient on the same dayeven at the same timeurologists must use the correct modifiers.
These two-surgeon procedures can include a urologist and a surgeon from a different specialty, two primary urologists, or one primary urologist and one assistant. Each scenario has a unique way to correctly code.
Two Surgeons, One Procedure: Modifier -62
Consider a case in which two surgeons are needed for the operation, and each surgeons specialty, talent or expertise is distinct and essential from the others. A prime example of a two-surgeon procedure involving a urologist is a pelvic exenteration for gynecologic malignancy (58240). In this case, a urologist may need to work with a gynecological oncologist or abdominal surgeon to complete the operation.
Note: This is also a case in which two urology subspecialists may work together on different aspects of the same procedure. For example, a uro-oncologist may perform the actual exenteration, while a uro-plastic surgeon is called in for the reanastomosis.
For this type of surgery, even though each specialist performed a distinct component of the operation, both surgeons distinct talent is needed to complete the procedure. One surgeon is not assisting the other. Therefore, each specialist will report the procedure 58240 (pelvic exenteration for gynecologic malignancy), along with the -62 modifier. The CPT manual explains modifier -62 as follows: When two surgeons work together as primary surgeons performing distinct part(s) of a single reportable procedure, each surgeon should report his/her distinct operative work by adding the modifier -62 to the single definitive procedure code.
The key to getting full reimbursement for the two-surgeon procedure is to provide documentation showing that each surgeons ability and expertise is distinct and medically necessary to complete the surgery. Both surgeons will bill for the procedure, and both must dictate a separate report that describes, in detail, their distinct parts in the operation. In addition, both should document the other surgeons role and mention that the other surgeon also will be dictating a report. Be sure to include the proper diagnosis codefor example, 183.0 (malignant neoplasm of ovary) or 183.2 (malignant neoplasm of fallopian tube).
As a result of the -62 modifier, each physician will receive a reduction in the normal fee schedule. It would be inappropriate to bill for the entire procedure when you didnt perform the entire procedure, says Anne Cunningham, RN, MBA, compliance manager for the Boston Medical Center.
When reimbursing the -62 modifier, Medicare will place the value of the procedure at 125 percent, then divide that equally between the two surgeons. This results in a payment of 62.5 percent for each physician. [...]
