2 surgeon question

[eagomar]

Hello,

I have a scenario which I'm just not sure exactly how it needs to be coded. A general surgeon went in to remove a malignant lesion from a patient's cheek for the second time (11643). He had consulted a plastic surgeon (different practice, tax id # etc) to be ready so that if the 2nd removal of the tumor were to expose bone and cartilage, then a flap advancement would have to be performed. The plastic surgeon ended up being called in and performed a flap advancement.

Question is - can the general surgeon bill for the excision of the tumor? It clearly states that the 11600+ codes are not to be separately reported w/ the 14000+ codes. And if they can be billed does a 62 modifier make sense??

Our practice has just taken on a surgical practice to code for and wasn't sure about this scenario.

Thank you!

[mitchellde]

Since this is two surgeons performing two completely separate procedures then each surgeon will bill for the procedure he/she performed and there is no need for a modifier. A 62 modifier is used when 2 surgeons each perform a part of the same procedure then each writes a note deailing which part he/she performed and each bills the same procedure code appending the 62 modifier.

[FTessaBartels]

Well, they're not exactly two separate procedures, since CPT tells us that the lesion removal should NOT be separately reported when the method of closure is an advancement flap.

However, 1404x does NOT accept a -62 modifier for co-surgeon, so although what was done here would generally be the kind of scenario where you would use the -62 modifier, in this case you cannot.

So, I agree with Debra. Each surgeon should code what s/he did. If the general surgeon is NOT going to do any follow-up but leave that to the plastic surgeon (or vice versa), I'd use the -54 modifier on the surgeon that won't be doing follow-up.

F Tessa Bartels, CPC, CEMC