Orthopedic Coding Alert

Co-surgery coding can be as tricky as the complex surgery that triggers it, but if you append modifier -62, both surgeons can recoup 62.5 percent of the procedure's fee. Medicare and CPT specify strict instructions for co-surgery billing, and if you don't coordinate the two physicians' claims carefully, one surgeon could lose his reimbursement entirely.

First Get Permission

Modifier -62 (Two surgeons) indicates to carriers that two surgeons' individual skills are required during the same surgical procedure. In such cases, each surgeon appends modifier -62 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) 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 may be better than one, neither CPT nor CMS allows billing for co-surgeons in every situation. Surgeons must determine which of the following four scenarios they meet before reporting co-surgeries, according to Medicare Physician's 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 some leg and knee surgeries, such as 27405-27447, various arm and elbow surgeries (24365-24435), and some replantations (20802-20838). Your documentation must show which special circumstances or skills required two surgeons to share responsibility. 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 V (labeled "co-surg") of the Physician Fee Schedule.

2. Procedures for which modifier -62 is allowable as long as each surgeon is of a different specialty: Examples of such procedures include arthrodesis 22532-22632 and pelvic fracture treatment 27215-27218.
These procedures are identified with a "2" in column V of the fee schedule database.

3. Procedures for which modifier -62 is never allowable: Such procedures are identified by a "0" in column V of the fee schedule database and include finger amputation codes 26910-26952 and hip x-ray injection codes 27093-27095, 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 V of the fee schedule database. Such procedures are relatively rare and include 20930 (Allograft for spine surgery only; morselized) and 20936 (Autograft for spine surgery only [includes harvesting the graft]; local [e.g., ribs, spinous process, or laminar fragments] obtained from same incision).
 
Both Medicare and private payers generally follow the guidelines set forth in the fee schedule database (although you may want to double-check with private payers). Before appending modifier -62 to any procedure code, therefore, check the fee schedule database to be sure the modifier is allowable and, if so, what documentation you'll need to justify the claim.
 
Note: To download the latest version of the CMS Physician Fee Schedule database, visit the CMS Web site at www.cms.gov.

Coordinate Your Coding

Medicare and many other payers reimburse procedures appended with modifier -62 at 125 percent of the regular fee schedule amount. The payer divides this between the two surgeons reporting the procedure, so each surgeon receives 62.5 percent of the standard fee.
 
For instance, a general surgeon and an orthopedic surgeon work together on anterior spine fusion, with the general surgeon performing the approach and the orthopedic surgeon performing the fusion. In this case, each surgeon would receive 62.5 percent of the fee schedule reimbursement for 22554 (Arthrodesis, anterior interbody technique, including minimal diskectomy to prepare interspace [other than for decompression]; cervical below C2), or about $820 each on average: