Wiki multiple specialty physicians from the same group - modifier question

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diannolo@ocfla.net

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i have 3 physicians who are in the same group, different specialties - ortho, hand surgery & podiatry all performed surgery on a patient during the same anesthesia session, each physician doing a different body part at different times, example: when the hand surgeon finished the ortho came in, and then the podiatrist. what modifier should each surgery be coded with? im thinking 58 but my co-worker is thinking 66.
the op note on each physician reads:
panel 1: drs name & surgery performed
panel 2: drs name & surgery performed
panel 3: drs name & surgery performed

thank you in advance for your input.
 
No extra modifiers are needed for this situation - the global period of one surgery does not apply to physicians of different specialties. Modifier 58 is not correct because the surgeries are reoperations by the same physician, and modifier 66 is also not correct because it is not a team surgery - as you've described, these were three separate and distinct surgeries that happen to have been done one after the other. Depending on the CPT codes billed, it is possible that one procedure may bundle into a procedure done by another provider, in which case the XP and XS modifiers may be appropriate to indicate the different provider and different body part, but other than that, you should not need any additional modifiers to get correct payments due to the multiple physicians.
 
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Multiple specialty physicians from the same group- modifier question

The only problem you sometimes encounter with multiple providers from the same group is when they all use the same NPI. If you are billing with a group NPI versus individual NPI's some insurance companies have rules regarding paying more than one procedure in one day.

I know we all try to make it convenient for the patient but you really should check with their insurance before you do the surgeries or two of the physicians may be operating for free.

Modifiers do not help in this case either.

If they are billing with individual NPI's you have a better chance of getting paid.When in doubt check with their insurance before the surgery.
I realize they are three different specialties with three different surgeries and probably three different diagnosis but that does not always mean they will get paid.

Good Luck.
Davieda Skobel CLPN, CPC
 
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