Wiki General Surgeons Helping in Spinal Surgery

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Amie Anderson

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I work for a nine physician general surgeon group and I wanted to see if there is anyone out there that would tell me how they bill for performing the general surgeon portion of these complex spinal surgeries. We have just been asked to start helping in the anterior approach portion of some of these surgeries that involve lumbar hemicorpectomies with decompression and anterior lumbar interbody fusions. Our doctor opens, discects and gets the spinal surgeon down to the operative field. Then the spinal surgeon performs his part with my physician holding retractors. After the spinal surgeon is done mine puts everything back and closes. I have been told different ways of coding this and wanted to see how others are billing these. I have been told to -62 the whole procedure, I have been told to -62 the hemicorpectomies and to -80 the remaining codes for the fusions, etc. and I've been told to just bill the fusions portion with a -62 modifier for the approach and leave it at that. Can anyone out there offer some advice on this? Thanks in advance!
 
It almost sounds as if your general surgeon performed in the capacity of co-surgeon (62). It does appear that your documentation could support an assistant (80), also; however, I would ask your physician for clarification and request a copy of the spine surgeon's dictation. It does sound as if your 2nd scenario would apply...

62 for the hemicorpectomies and 80 for the fusion, etc.

Below is an article from the AAOS that you may find helpful.


http://www2.aaos.org/aaos/archives/bulletin/jun98/codngcol.htm
 
We bill cosurgery-62 on only the code that includes the anterior approach. Example codes 22554-22558, or 22857 The other codes we bill the assist-80.

If you are just starting this, be watchful of your Blue Cross Blue Shield plans. Our local BCBS has a medical policy on it. They still think total disc arthroplasty is experimental, therefore not covered.

Hope this helps.
 
General surgeon's involvement

Our general surgeons only do the opening and closing of these cases. They do not stay to assist the orthopedic (or neuro) surgeon in the remainder of the case. So we only bill the basic procedure with a -62 modifier.

However, we have residents and fellows to do the assist (academic medical center). It sounds as if your general surgeon will actually stay scrubbed in on the case and assist. In that case, I think Rebecca was right that you'll want to also use the -80 modifier as appropriate (check the codes to see if they take an assist).

Your surgeon will have to dictate his/her own operative note for the procedure requiring the -62 modifier.

Hope that helps.

F Tessa Bartels,CPC, CEMC
 
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