Wiki Assistant to Neurology

[medicalsec]

Our doctor did a retroperitoneal exposure, and a Neurosurgeon and a Vascular surgeon were all involved in the case. The neuro listed our doctor as his assistant, and the Vascular surgeon listed our doctor as the second assistant. They were removing a tumor, which involved the arteries and the nerves. The problem is that none of them want to bill as consurgeons or as a team. It was my understanding that our doctor can't bill independently for the exposure (49010). I am not sure at this point what codes they are going to use, but it would seem that if they were all working through the same incision that some would need to bill at a reduced rate because they were all working in the area that our doctor exposed through his approach. Any thoughts would be appreciated.

Thanks,

Dee

 

[FTessaBartels]

Team - 66 mod

What the neurosurgeon and vascular surgeon want isn't the same as what should be coded.

I think this should be accurately coded as a team (-66 modifier).

Each surgeon should dictate his/her own operative note describing the part s/he played in the total surgery.

You will have to coodinate with these other surgeons so that everyone uses the same basic code with -66 modifier (for example: 58957-66).

If either of the surgeons did some additional procedure from the basic procedure, s/he can code that separately (assuming it doesn't bundle).

I know that surgeons hate this ... but they can't expect to be paid a full fee if they didn't perform EVERYTHING associated with the surgery ... they relied on the general surgeon to open/close, so the team modifier seems appropriate.

F Tessa Bartels, CPC, CEMC

 

[RebeccaWoodward*]

Based on what you have said, I agree with you. When our neurosurgeons work with a general surgeon, they bill as co-surgeons. Access and closure are an inherent part of the surgical procedure. You cannot "separate out" the exposure for coding purposes or for separate payment. Since the vascular surgeon and neurosurgeon are working together to provide a single indentifiable procedure, It should be reported with modifier 62 or team...whichever is applicable. I would reference this with 40.8. That's my .2 cents.

http://www.cms.hhs.gov/manuals/downloads/clm104c12.pdf