Observe Documentation Requirements for Proper Modifier 62 Reimbursement
If two surgeons act as co-surgeons, they must likewise coordinate their documentation and billing to ensure that each receives proper reimbursement.
When two surgeons work together to perform distinct portions of a procedure identified by a single CPT® code, each surgeon will report the appropriate code with modifier 62 Two surgeons appended. Each surgeon must serve as the primary surgeon during some portion of the procedure. For example, per CPT® Assistant (February 2002), “In some cases, one surgeon may perform the approach procedure for anterior spine surgery, including making the incision and exposing the area requiring surgery, while another surgeon then performs the definitive procedure on the spine. Following completion of the definitive procedure, the first physician returns to perform the closure of the operative site. Therefore, two surgeons have performed the work included in one total procedure, reportable with a single code.”
Medicare (and many other payers) will recognize modifier 62 only with certain codes, as identified in the “CO-SURG” column of the National Physician Fee Scheduled Relative Value File.
- If the CO-SURG column includes a “1” indicator: You may append modifier 62, but documentation must show which special circumstances or skills required two surgeons to share responsibility.
- If the CO-SURG column includes a “2” indicator: You may append modifier 62 as long as each of the operating surgeons is of a different specialty.
- If the CO-SURG column includes a “0” or “9” indicator: Medicare does not allow modifier 62 with that code.
When submitting claims with modifier 62, each physician must document his or her own operative notes, detailing what portion of the procedure he or she performed, how much work was involved, how long the procedure took, etc. Each physician should identify the other as a co-surgeon; both surgeons should link the same diagnosis to the common procedure code; and each will submit his or her own claim.
Medicare and many other payers pay for codes appropriately submitted with modifier 62 at 125 percent of the usual fee schedule amount. The payer divides this between the two surgeons reporting the procedure, so each surgeon receives 62.5 percent of the regular fee. If the operating surgeons fail to coordinate their claims, however, one or both surgeons may not receive the earned reimbursement. For instance, if surgeon A sends his claim without a modifier appended, and his claim is the first to reach the payer, surgeon B (who acted as a co-surgeon) may have his or her claim rejected as a duplicate.