General Surgery Coding Alert

Coding can become tricky when two surgeons work together during the same surgery. Medicare and CPT specify strict instructions for co-surgery billing, and if you dont coordinate the two physicians claims carefully, one surgeon could lose his or her reimbursement entirely. First You Must Know if Its Allowable Modifier -62 (Two surgeons) indicates that the individual skills of two surgeons are required during the same surgical procedure. In such cases, each surgeon codes independently of the other, with modifier -62 appended to the applicable CPT procedure code(s), says Laureen Jandroep, OTR, CPC, CCS-P, CPC-H, CCS, director and senior instructor for CRN Institute, an online coding certification training center based in Absecon, N.J.
 
Section 15044 of the Medicare Carriers Manual (MCM) further specifies that co-surgeons share responsibility for a surgical procedure, each serving as a primary surgeon during some portion of the surgery. Both must be surgeons and are frequently but not necessarily of different specialties. The MCM further specifies that co-surgeons share pre- and postoperative responsibility for the patient. 
 
Although two heads are generally better than one, neither CPT nor CMS allows billing for co-surgeons in every situation. Surgical procedures fall into one of four categories with respect to co-surgeons, as outlined in the Physician Fee Schedule database:
 
1. Procedures for which modifier -62 is allowable, but supporting documentation is required to establish medical necessity for two surgeons, regardless of specialty: This category includes embolectomy/thrombectomy (34001-34490), direct aneurysm repair or excision and graft insertion for aneurysm (35001-35112), and esophageal repairs (43300-43425). Your documentation must show what special circumstances or skills required the surgeons to share responsibility for the patient. For example, the extraordinary duration of a trauma surgery may require that two surgeons work in shifts, allowing each to scrub out while the other continues the procedure. Or they may work simultaneously but perform distinct components of a procedure.

These procedures are identified with a 1 in column U (labeled co-surg) of the Physician Fee Schedule database.

 2. Procedures for which modifier -62 is allowable as long as each surgeon is of a different specialty: Examples of such procedures include endovascular abdominal aortic aneurysm repair 34800-34832 and transluminal atherectomy 35480-35485.
 
These procedures are identified with a 2 in column U of the fee schedule database.
 
3. Procedures for which modifier -62 is never allowable: Such procedures are identified by a 0 in column U of the fee schedule database and include lesion removal 11400-11646 and breast incision/excision 19000-19272, among others.
 
4. Procedures for which the concept of co-surgeons does not apply, and for which modifier -62 is therefore inappropriate: These procedures are noted by a 9 in column U of the fee schedule database. Such procedures are relatively rare and include minor services such as naso- or oro-gastric [...]