General Surgery Coding Alert

Don't forget the modifier for distinct services.

You'll no longer have to forfeit pay when your surgeon performs a distinct part of certain laparoscopic procedures with another surgeon, thanks to several recent Medicare Physician fee schedule changes. CMS recently offered the good news for several co-surgery codes in Transmittal 2276, with an Oct. 3, 2011 implementation date.

CMS will change the co-surgery indicator for spleen surgery code 38129 (Unlisted laparoscopy procedure, spleen) from "0" (Co-surgeons not permitted) to "1" (Co-surgeons could be paid, supporting documentation required to establish medical necessity of two surgeons for the procedure).

Ensure documentation: Keep in mind that you must provide supporting documentation when billing for a co-surgeon with these procedures, so don't forget to submit that with your claim or you'll be looking at bad news.

The same rule holds true for the following laparoscopy codes (among others), which previously were not permitted with co-surgeons, but now also have a "1" indicator:

• 38589 -- Unlisted laparoscopy procedure, lymphatic system
• 43289 -- Unlisted laparoscopy procedure, esophagus
• 43659 -- Unlisted laparoscopy procedure, stomach
• 44238 -- Unlisted laparoscopy procedure, intestine (except rectum).

Capture Pay With Modifier 62

When two physicians perform distinct, separate portions of the same procedure represented by a single CPT code, append modifier 62 (Two surgeons) to each surgeon's procedure code.

Also referred to as co-surgery, modifier 62 indicates that each physician completed a single procedure within the overall surgery. Look for a hint in the operative notes, says Barbara J. Cobuzzi, MBA, CPC, CPC-H, CPC-P, CENTC, CHCC, senior coder and auditor for The Coding Network, and president of CRN Healthcare Solutions. Both surgeons should dictate their own op notes to describe their roles in that single procedure, she says.

For modifier 62 claims, most payers pay an additional fee (generally 125 percent of the "usual" fee for the procedure, split evenly between the two surgeons).

Catch: You shouldn't use modifier 62 if the surgeons are not reporting the same CPT code. If each surgeon can represent his work with a separate CPT code, skip modifier 62 and let each surgeon separately bill the procedure he performed.