Wiki Two Surgeons of Same Specialty and a MIGS Subspecialty

[LRChilders]

Looking for opinions on how to code two surgeons of the same specialty when second surgeon is needed due to his expertise and certification as a Minimally Invasibve Gynecologic Surgery (MIGS) "specialist". (non-boarded subspecialty)

Example #1:
Provider "A" is performing a RALH on a patient. Extensive endometriosis is noted. Provider "B" is called in as a consult due to his expertise (MIGS certification). Provider B's work is more than the typical assistant surgeon, more equivalent to co-surgeons. Both document OP notes. Both are from the same practice, same specialty (OB/GYN) but provider B has a non-boarded subspecialty, focused practice designation.

Can co-surgeon modifier 62 be reported?

Example #2:
Same scenario as above. However, Provider "A" performs the RALH and Provider "B" perfoms the LOA for the extensive endometriosis. Providers document seperate OP notes.

Thoughts?

 

[csperoni]

Part of this depends on the carrier. Part of this depends on the CPT performed.
Medicare (or at least my MAC NGS) does not pay for co-surgeons unless the providers are 2 different specialties. In your example, both physicians would fall under the CMS specialty of 16 Obstetrics/Gynecology. NGS would not pay for co-surgeons in your example.
Other carriers might follow CMS guidance, or may have their own policy. Additionally, many commercial carriers will credential by TAXONOMY, not CMS 2 digit specialty codes. The taxonomy codes allow for many additional subspecialties and nuances. For example, under the OBGYN heading, there are 10 subspecialty taxonomy codes. I will note that MIGS is not one of them. My insurance contracts follow CMS guidelines, but your carriers could vary.
IF your carrier allows same specialty co-surgeons, then both of these would be eligible for 5857___-62. Not all procedures are eligible for co-surgeons, but laparoscopic hysterectomies are.
If your carrier does not, your only option is primary/assist in both of these. If your clinicians are compensated based on wRVUs and this is a common situation, you may want to figure some internal way to more equitably distribute the work.