Observe Documentation Requirements for Proper Modifier 62 Reimbursement

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  • December 2, 2013
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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.


John Verhovshek
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John Verhovshek, MA, CPC, is a contributing editor at AAPC. He has been covering medical coding and billing, healthcare policy, and the business of medicine since 1999. He is an alumnus of York College of Pennsylvania and Clemson University.

No Responses to “Observe Documentation Requirements for Proper Modifier 62 Reimbursement”

  1. Natalie Henderson says:

    I am looking for more information on the documentation requirements for a co surgeon. My surgeon just put the name of the other provider at the top of the op report but doesn’t mention anything in the body of the report. This doesn’t seem correct to me but I need proof to send to my doctor.

  2. Betty Plunkett says:

    My billing manager insists that I append a modifier 62 to most surgical line items for the primary neurosurgeon and an 80 for the assistant neurosurgeon.
    Wouldn’t putting a 62 on each line item discount the amount the insurance will pay based on a discount of 62.5%?

  3. Jess says:

    Betty, I think you are getting cosurgeon and assistant surgeon confused.

  4. kim says:

    Can anyone give feedback or help me find documentation on billing co-surgeon and assist on the same claim. If we are asked by another specialty to act as co-surgeon we of course bill with modifier 62 on primary procedures however since modifier 62 cannot be appended to instrumentation codes we bill with 80 on instrumentation however we are getting denials now on the instrumentation codes stating no qualifying base code is being used due to the the primary procedure being billed with 62 makes the TOS 2 and 80 makes TOS 8.
    Thanks in advance.