Neurology & Pain Management Coding Alert

Neurosurgeons often work with physicians of other specialties, particularly orthopedic, general and thoracic surgeons. For example, in complex spine procedures,
a neurosurgeon frequently will perform the surgery with other specialities or a general surgeon. Modifier -62 (two surgeons) is used in these situations to optimize reimbursement.

Modifier -62 is used to append a CPT code that is shared by two surgeons. Medicare and most private carriers allow an additional 25 percenta total of 125 percentreimbursement for a procedure when modifier -62 is used. This is then split between the two co-surgeons62.5 percent to each. The 125 percent payment can be split in different proportions, but only if both co-surgeons make such a request in writing to Medicare or the insurance carrier. Be prepared to wait longer for the payment to be processed if such a request is made.

Recall Changes for Modifier -62

Coders should remember the substantial changes in the use of the -62 modifier this year that affect their billing practices. Before 1990, if you used modifier -62 you could not be an assistant (denoted by modifier -80) at the same time. Therefore, you could not use the -80 modifier, says Gregory J. Przybylski, MD, an assistant professor of neurosurgery at Thomas Jefferson University in Philadelphia and a CPT editorial panel advisor to the American Medical Association (AMA), representing the Congress of Neurological Surgeons.

Now you can only use modifier -62 on a single code, he says. But you can use -80 and -62 in the same session. That was the tradeoff, says Przybylski.

Another change effective this year: The requirement that co-surgeons using the -62 modifier be in different specialties was dropped. So, now you can be in the same specialty and use modifier -62, although thats unlikely. It would be very difficult to prove the medical necessity for co-surgeons if both are neurosurgeons.

Under this arrangement, neurosurgeons stand to be reimbursed more since they are doing an equal split only on the highest relative value code.

There is definitely some confusion about modifier
-62, says Kim Pollock, RN, MBA, a consultant with Karen Zupko and Associates, a practice management consulting firm based in Chicago. Pollock specializes in neurosurgery coding.

Probably the most frequent misconception is that modifier -62 can be used for an assistant surgeon. Its abused this way. It should be used only when two surgeons are doing different parts of an operation, as opposed to modifier -80, where one surgeon is just assisting the other.

The same surgeon can claim a -62 on one procedure and bill an -80 on all the others. What is not appropriate is to bill modifiers -62 and -80 plus the primary surgeons code in the same session. You cant play three roles. [...]