Neurosurgery Coding Alert

Co-surgeon status is denoted by attaching modifier -62 (two surgeons) to the procedure, which CPT 2000 defines as when two surgeons work together as primary surgeons performing distinct part(s) of a single reportable procedure, each surgeon should report his/her distinct operative work by adding modifier -62 to the single definitive procedure code. Each surgeon should report the co-surgery once using the same procedure code.

Co-surgery commonly occurs when a single procedure requires the talents of two different specialties or sub-specialties. In this case study, the neurosurgeon using the retroperitoneal approach to perform disc surgery requires the services of a vascular surgeon to access the surgical site.

Case Description

The patient is a 55-year-old male with a diagnosis of a fracture of vertebral column without mention of spinal cord injury; lumbar, closed (805.4) and pathologic fracture of vertebrae (733.13).

Coding Notebook

The operative procedures begin with a description of the work performed by the vascular surgeon and the neurosurgeon acting as a co-surgeon. Code 63090 (vertebral corpectomy [vertebral body resection], partial or complete, transperitoneal or retroperitoneal approach with decompression of spinal cord, cauda equina or nerve root(s), lower thoracic, lumbar, or sacral; single segment) would be billed with a -62 modifier (two surgeons) by both surgeons.

Once the vascular surgeon accessed the site, however, the neurosurgeon, performed additional procedures. These include 22558 (arthrodesis, anterior interbody technique, including minimal diskectomy to prepare interspace [other than for decompression]; lumbar) and 22585 ( each additional interspace). Because the fusion extended over two interspaces, 22845 (anterior instrumentation; two to three vertebral segments) was billed for the instrumentation inserted to stabilize the spine and 20931 (allograft for spine surgery only; structural) was billed for the bone graft that was used as an additional strut for the spine. For these procedures the vascular surgeon was no longer a co-surgeon; he or she assisted during these services and should bill using modifier -80 (assistant surgeon). The neurosurgeon would bill these procedures without a modifier.

Be Careful Not to Confuse Modifier Use

Both surgeons would submit separate claims for 63090 with modifier -62 attached. In addition, both surgeons should submit separate operative reports describing the procedure. The same diagnosis codes should be used and the documentation of both surgeons needs to state that they were co-surgeons for the procedure, says Barbara Cobuzzi, MBA, CPC, CHBME, president of Cash Flow Solutions, a coding and reimbursement consulting firm in Lakewood, N.J.

According to CPT guidelines regarding modifier -62 use, it is acceptable to bill as a co-surgeon on one procedure and as an assistant surgeon on another. As a result, some private carriers may accept such claims. Many Medicare carriers, however, may not allow payment for a co-surgeon and an assistant [...]