Wiki How to code 2 different surgeries & surgeons, different specialties?

[jdibble]

I work for a multi-specialty practice and we have an upcoming surgery that we are debating on how to code/bill! Our General Surgeon is going to be doing a ventral Hernia repair on a patient. After he is done repairing the hernia, the Plastic Surgeon will be removing excess skin on the patient (an abdominoplasty?) and then performing the closure. The hernia repair is covered under insurance, the skin removal is not. The plastic office wants us to bill the full hernia repair to insurance and then charge the patient for just the skin removal portion. They do not want to bill the insurance at all for the abdomioplasty portion - so they don't want me to code that operation.

How would this be billed? Should I bill the hernia repair with a 52 modifier for reduced services since the General Surgeon did not close? And if this is correct, can we then bill the patient for the extra cost of closing? Should I bill the procedure in full and list the Plastic as an Assistant Surgeon? Or a Co-surgeon?

I welcome as many opinions I can get...along with any documentation anyone might have to substantiate the answers. The Plastic Surgeon is stubborn and wants everything in writing!

Thanks,

 

[FTessaBartels]

Co-surgeons

What you describe ... if I understand correctly ... is what they PLAN to do. So you don't have any operative note at this point.

I can't tell for certain because we have no op notes, but I am thinking that I would bill the hernia repair for each surgeon with the -62 co-surgeon modifier.

If there is significant work involved in removing the excess skin before closure, you might want to add a -22 modifier on the code as well. But until you have the actual operative notes you can't tell whether this is even documented, much less whether it's significantly more work.

Hope that helps.

F Tessa Bartels, CPC, CEMC

 

[jdibble]

Not done yet!

Thanks Tessa for your help!

No, this has not taken place yet. They are trying to figure out how to bill this because the portion of the surgery that the Plastic Surgeon will be doing - the excess skin removal - apparently is not covered by insurance and the patient will be responsible for paying these charges up front. They do not want me to code and submit this portion of the surgery. So the only charge going to the insurance is the Hernia repair - however the General Surgeon would not be closing - the Plastic Surgeon would. So would this then be considered a co-surgeon or assistant? The Plastic surgeon would be dictating her own report, which would detail the excess skin removal along with the closure - but the only portion of the Hernia repair that she would be doing is the closure.

Thanks,