Urology Coding Alert

Whether performing a joint procedure or assisting with intraoperative complications, don't be surprised when your urologist works with an ob-gyn and don't let it be the cause of a denied claim.

One of the most common scenarios that require the work of both a urologist and an ob-gyn is a bladder suspension and a hysterectomy performed at the same surgical session.

Thanks to CPT Codes 2003, there are two codes to account for the work performed by the urologist and the gynecologist: 58267 (Vaginal hysterectomy, for uterus 250 grams or less; with colpo-urethrocystopexy [Marshal-Marchetti-Krantz type, Pereyra type] with or without endoscopic control) and 58293 (Vaginal hysterectomy, for uterus greater than 250 grams; with colpo-urethrocystopexy [Marshall-Marchetti-Krantz type, Pereyra type] with or without endoscopic control), which would be reported by both physicians, each with modifier -62 (Two surgeons).

If one specialist is performing one part, or component, of a procedure and another specialist is performing another part of the procedure, they are considered co-surgeons and should each report the same CPT code with modifier -62, says Margaret Lamb, RHIT, CPC, with Great Falls Clinic in Great Falls, Mont. Using modifier -62, each surgeon will receive 62.5 percent of the allotted fee for the service, she says.

But what if the services performed by the two specialists aren't represented in a single code?

"If two surgeons are working on performing two distinct procedures during the same surgical session, you can't use modifier -62" and call the surgery a co-surgery because the physicians won't be reporting the same code, Lamb says. In this case, "each physician should report the code for the service he provided, without a modifier."

For example, a patient undergoes a vaginal hysterectomy and a sling procedure. In this case, each surgeon should report a separate code(s) to represent his individual service(s): The urologist would report 57288 (Sling operation for stress incontinence [e.g., fascia or synthetic]), and the gynecologist would report either 58260 (Vaginal hysterectomy, for uterus 250 grams or less) or 58262 (... with removal of tube[s], and/or ovary[s]). When two separate codes are reported, modifier -62 is no longer applicable. And when two separate codes are reported, each physician should receive the full fee allotted for the service he reports, Lamb says.

4 Tips to Remember When Using Modifier -62

When two surgeons work together to perform one procedure, each physician's individual documentation requirements can get jumbled.

Make sure your urologist isn't passing the documentation buck and that he or she knows to follow these four guidelines when you submit claims with modifier -62.
1. Each physician should identify the other as a co-surgeon. "Make sure the other physician is billing with modifier -62," Lamb says. "Alot of confusion can arise when physicians from different practices are reporting the same procedure." She cites the possibility that one physician may report the other physician's work as that of an assistant surgeon, in which case the claims would not correspond and would be denied. It is not enough for just one surgeon to indicate the other as the co-surgeon. It is imperative that both physicians submit claims for the same procedure, both with modifier -62. You can accomplish this with a simple courtesy call to the other physician's billing or coding department, she says.
2. Each physician should document her own operative notes. When surgeons are acting as "co-surgeons" it is implied that they are each performing a distinct part of the procedure which means they can't "share" the same documentation, says Linda Parks, MA, CPC, CCP, coding specialist for GI Diagnostics Endoscopy Center in Marietta, Ga. Each physician should provide a note detailing what portion of the procedure she performed, how much work was involved, and how long the procedure took. Including a brief explanation of the need for co-surgeons will help to avoid denials and reimbursement delays.
3. Each physician must link the same diagnosis code to the common procedure code. Though this requirement may seem obvious, if two physicians serve as co-surgeons to perform one procedure, the diagnosis code(s) they link to the CPTcode should be the same and it almost always will be, Parks says. Before submitting a claim with modifier -62, someone in the practice must confirm that both claims have the same ICD-9 code(s).
4. Each physician must submit his own claim with his own documentation. Because claims for co-surgeons of the same specialty can come under scrutiny, it is imperative that each physician diligently detail both the work he performed and the work the other physician performed. Many physicians even submit a letter to the carrier detailing the reason for two surgeons. Because so much coordination of claims goes on with modifier -62, get a game plan together outlining what each surgeon is going to do to complete the procedure and how they are both going to document and code for it this is one surefire way to improve your chances of getting the reimbursement you deserve on the first try.