Neurosurgery Coding Alert

A new subscriber recently wrote in, asking how to correctly use modifier 62 (Two surgeons). You may need to use this modifier if your neurosurgeon works together as a co-surgeon with another surgeon to perform one procedure. However, as you well know, modifiers can be tricky. For example, modifier 62 comes with very specific rules you must follow if you want to submit clean claims.

Bust these myths to make sure you always append modifier 62 appropriately on your neurosurgery claims.

Myth 1: You Can Append Modifier 62 for Assistant Surgeon

Reality: No. Modifier 62 applies to co-surgeons, not assistant surgeons. There is an important distinction between the two.

First, to qualify for modifier 62, your neurosurgeon must have worked together with another surgeon and they both must be considered primary surgeons or co-surgeons.

Once you have confirmed that your neurosurgeon was indeed a primary co-surgeon, you must confirm that your neurosurgeon worked together with the other surgeon to complete a procedure described by a single CPT^® procedure code.

“When two surgeons work together as primary surgeons performing distinct part(s) of a procedure, each surgeon should report his/her distinct operative work by adding modifier 62 to the procedure code and any associate add-on code(s) for that procedure as long as both surgeons continue to work together as primary surgeons,” according to CPT^®. “Each surgeon should report the co-surgery once using the same procedure code.”

Bottom line: Modifier 62 applies for only one primary procedure and its related add-on codes for each surgeon.

Don’t miss: On the other hand, if your neurosurgeon was an assistant surgeon, you would instead look to other modifiers such as modifier 80 (Assistant surgeon), modifier 81 (Minimum assistant surgeon), and modifier 82 (Assistant surgeon [when qualified resident surgeon not available]).

Myth 2: Your Surgeon Does Not Have to Identify Other as Co-Surgeon

Reality: When you append modifier 62, your surgeon must identify the other surgeon as a co-surgeon. You must make sure that the other surgeon is going to submit the claim with modifier 62. This is very important because if your neurosurgeon reports the other physician’s work as a co-surgeon, but the other physician reported your neurosurgeon as an assistant surgeon, your claim will be denied.

Also, you could check in with the other physician to double check that both your neurosurgeon and the other physician are reporting the same CPT^® code to represent the procedure both physicians performed as co-surgeons.

Myth 3: Only One Surgeon Has to Submit Documentation

Reality: To bill as co-surgeons, each physician must submit his own claim with his own medical documentation.

Since each physician performed a distinct part of the procedure, their documentation won’t be the same. Your neurosurgeon must include what portion of the procedure he performed, how much work was involved, and how long the procedure took. Your neurosurgeon should also explain why co-surgeons were needed for that particular procedure.

Myth 4: You Don’t Have to Use Same ICD-10-CM Codes

Reality: If you use modifier 62, then each physician who is identifying as a co-surgeon must link the same diagnosis code to the common procedure code. So, before you submit your claim with modifier 62, someone in your practice must confirm that both your physician and the other physician’s claims contain the same ICD-10-code(s).

Myth 5: Co-Surgery Indicators Don’t Matter

Reality: You should always check the Medicare physician fee schedule (MPFS) database to see if the procedure you are reporting qualifies for modifier 62. To be eligible for payment, the procedure code must have a Medicare co-surgery indicator of either “1” or “2.” If not, your physicians cannot code and bill as co-surgeons for that procedure.

“There are some common categories of procedures for which reporting co-surgery is not permitted,” says Gregory Przybylski, MD, immediate past chairman of neuroscience and director of neurosurgery at the New Jersey Neuroscience Institute, JFK Medical Center in Edison, New Jersey. “These generally include percutaneous procedures, placement of spinal instrumentation, and harvest of bone graft for spine procedures.”

1. If the code carries a co-surgery indicator of “1,” you must supply documentation to establish medical necessity for two co-surgeons. Only when you establish medical necessity clearly will a payer consider additional reimbursement. You should present which circumstances in the procedure required special skills or expertise by two co-surgeons sharing a responsibility.

2. A “2” in the co-surgery column indicator means that you may append modifier 62 as long as each of the operating surgeons is of a different specialty.