Wiki SPINE SURGERY W/ CO-SURGEON AND ASSIST QUESTION

[katz0813]

Hello,

My doctor (Ortho) performed specific procedures of the following surgery, and a co-surgeon (Vascular) also performed specific procedures. The twist is that he (Ortho) also performed parts of the surgery with an assistant/PA.
I have yet to come across this, so my question is....HOW DO I BILL THIS???
Thanks in advance for any help!





Would I bill 4 claims?

1. One for him w/mod 62.
2. One for the co-surgeon with modifiers 62

3. One with him with no modifiers
4. One for the assistant/PA with modifier AS

 

[haraml7]

HI,
There are a few questions that arise for me in your description above. I have pulled the CMS guidelines for your review. Please don't hesitate to reach out if you have anymore questions.

40.8. - Claims for Co-Surgeons and Team Surgeons
(Rev. 3721, Issued: 02-24-17, Effective: 05-25-17, Implementation: 05-25-17)
A. General
Under some circumstances, the individual skills of two or more surgeons are required to perform surgery on the same patient during the same operative session. This may be required because of the complex nature of the procedure(s) and/or the patient’s condition. In these cases, the additional physicians are not acting as assistants-at-surgery.
B. Billing Instructions
The following billing procedures apply when billing for a surgical procedure or procedures that required the use of two surgeons or a team of surgeons:
• If two surgeons (each in a different specialty) are required to perform a specific procedure, each surgeon bills for the procedure with a modifier “-62.” Co-surgery also refers to surgical procedures involving two surgeons performing the parts of the procedure simultaneously, i.e., heart transplant or bilateral knee replacements. Documentation of the medical necessity for two surgeons is required for certain services identified in the MFSDB. (See §40.8.C.5.);
• If a team of surgeons (more than 2 surgeons of different specialties) is required to perform a specific procedure, each surgeon bills for the procedure with a modifier “-66.” Field 25 of the MFSDB identifies certain services submitted with a “-66” modifier which must be sufficiently documented to establish that a team was medically necessary. All claims for team surgeons must contain sufficient information to allow pricing “by report.”
• If surgeons of different specialties are each performing a different procedure (with specific CPT codes), neither co-surgery nor multiple surgery rules apply (even if the procedures are performed through the same incision). If one of the surgeons performs multiple procedures, the multiple procedure rules apply to that surgeon’s services. (See §40.6 for multiple surgery payment rules.)
For co-surgeons (modifier 62), the fee schedule amount applicable to the payment for each co-surgeon is 62.5 percent of the global surgery fee schedule amount. Team surgery (modifier 66) is paid for on a “By Report” basis.

 

[daniel]

Looks like 3 claims?

1. One for him w/mod 62. Ortho
2. One for the co-surgeon with modifiers 62 vascular

3. One for the assistant/PA with modifier AS ortho PA.
4 . line with no modifier for ortho if he’s performing a separate procedure outside the co surgery.

 

[katz0813]

HI,
There are a few questions that arise for me in your description above. I have pulled the CMS guidelines for your review. Please don't hesitate to reach out if you have anymore questions.

40.8. - Claims for Co-Surgeons and Team Surgeons
(Rev. 3721, Issued: 02-24-17, Effective: 05-25-17, Implementation: 05-25-17)
A. General
Under some circumstances, the individual skills of two or more surgeons are required to perform surgery on the same patient during the same operative session. This may be required because of the complex nature of the procedure(s) and/or the patient’s condition. In these cases, the additional physicians are not acting as assistants-at-surgery.
B. Billing Instructions
The following billing procedures apply when billing for a surgical procedure or procedures that required the use of two surgeons or a team of surgeons:
• If two surgeons (each in a different specialty) are required to perform a specific procedure, each surgeon bills for the procedure with a modifier “-62.” Co-surgery also refers to surgical procedures involving two surgeons performing the parts of the procedure simultaneously, i.e., heart transplant or bilateral knee replacements. Documentation of the medical necessity for two surgeons is required for certain services identified in the MFSDB. (See §40.8.C.5.);
• If a team of surgeons (more than 2 surgeons of different specialties) is required to perform a specific procedure, each surgeon bills for the procedure with a modifier “-66.” Field 25 of the MFSDB identifies certain services submitted with a “-66” modifier which must be sufficiently documented to establish that a team was medically necessary. All claims for team surgeons must contain sufficient information to allow pricing “by report.”
• If surgeons of different specialties are each performing a different procedure (with specific CPT codes), neither co-surgery nor multiple surgery rules apply (even if the procedures are performed through the same incision). If one of the surgeons performs multiple procedures, the multiple procedure rules apply to that surgeon’s services. (See §40.6 for multiple surgery payment rules.)
For co-surgeons (modifier 62), the fee schedule amount applicable to the payment for each co-surgeon is 62.5 percent of the global surgery fee schedule amount. Team surgery (modifier 66) is paid for on a “By Report” basis.

I'm not sure if Team Surgeon applies here as the PA is a Physician Assistant, and not a Physician. I was under the impression that when billing co-surgeons, they needed to be mirror images of each other. With that being said, am I able to put the procedures which my ortho doc performed with my PA assisting, on the same claim in which I am billing his co-surgeon procedures, mod 62, with Vascular? Total claims would be: 3 Ortho, Vascular, PA.

 

[iowagirl77]

-Assuming this was done all in one day, bill the ortho physician with all the charges, but put the 62 modifier on just the arthrodesis. Generally they just perform the access for the fusion from what I have seen. You don't have to split the charges between claims if it was all on the same day.
-If you also code for the vascular surgeon, bill the arthrodesis with 62 (and then any other procedures he might have performed on his own).
-The assistant will have their own claim also with AS modifier.

 

[katz0813]

-Assuming this was done all in one day, bill the ortho physician with all the charges, but put the 62 modifier on just the arthrodesis. Generally they just perform the access for the fusion from what I have seen. You don't have to split the charges between claims if it was all on the same day.
-If you also code for the vascular surgeon, bill the arthrodesis with 62 (and then any other procedures he might have performed on his own).
-The assistant will have their own claim also with AS modifier.

Thank you so much for your feedback! I was hoping a COSC would answer this! I didn't want to assume anything, as this is something new my ortho doc has started doing with a vascular surgeon.

 

[katz0813]

Looks like 3 claims?

1. One for him w/mod 62. Ortho
2. One for the co-surgeon with modifiers 62 vascular

3. One for the assistant/PA with modifier AS ortho PA.
4 . line with no modifier for ortho if he’s performing a separate procedure outside the co surgery.

Thanks Daniel for your feedback! Never want to start coding something wrong and establish a pattern!