Modifier 62 Is Your Route To Clean Co-surgeon Claims

You should watch your surgeon's op note for second surgeon signs

. For instance, did another surgeon help with approach or closure? If yes, you will have to take some adsitional steps to get your deserved reimbursements:

Look to modifier 62 for co-surgeons

When two surgeons work together to carry out distinct portions if a procedure CPT identifies with a single reportable code, you will need to access modifier 62 (Two surgeons.

Suppose a neurosurgeon carries out an anterior approach arthrodesis, and requests a general surgeon to expose the surgical area and close the patient following the procedure. The neurosurgeon carries out the arthrodesis, along with related bone graft and instrumentation procedures.

When a general surgeon does the exposure for a spine case, go for modifier 62. Both surgeons are carrying out distinct portions of the procedure.

The neurosurgeon and general surgeon should report the same CPT and diagnosis codes. You should even send copies of both physicians' operative notes with your claim.

Cooperation matters in medical coding

When reporting co-surgeries, you should work closely with the other operating surgeon's staff to see to it that each practice gets its fair share of the reimbursement. Both doctors need to dictate their portion of the procedure in order to fulfil the requirements of the co surgeon modifier.

Medicare and most payers reimburse procedures coded with modifier 62 at 125 percent of the regular fee schedule amount. The payer divides this between the two surgeons reporting the procedure; as such each surgeon gets 62.5 percent of the standard fee. However, do not change your fee in anticipation of the adjustment. Charge your normal fee for your physician's services and allow the insurer to make the adjustment.

For modifier advice, check fee schedule

To confirm that the procedure you wish to report qualifies for modifier 62, check the Medicare physician fee schedule (MPFS) database. In order to be eligible for payment, ensure that the procedure codes have a Medicare co-surgery indicator of either 1" or 2." If not, your doctors cannot code and bill as co-surgeons for that procedure.

For detailed information on this, sign up for a medical coding guide like Supercoder.

by: James Article

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