Otolaryngology Coding Alert

To use modifier 62, you've got to meet certain requirements -- including both surgeons reporting the same code and that code carrying an eligible co-surgeon indicator.

These survival tips can make modifier 62 friendlier to your eyes and eliminate whatever doubts you have about its functionality.

When two surgeons (such as a general surgeon and otolaryngologist) cooperate to perform a surgery within the same body cavity and with a single goal, each of them applies his own expertise to achieve that single goal. At the same time, they assist and complement each other.

To bill for co-surgery, both surgeons must bill using the same CPT codes and append modifier 62.

According to the 2009 Otolaryngology Coders Survival Guide, you should append modifier 62 "when two surgeons work together to complete a procedure described by a single CPT procedure code. Note, however, that not all procedures qualify for reimbursement with modifier 62. In addition, you will have to meet specificdocumentation requirements to apply modifier 62 accurately and effectively."

The AMA has a more distinct descriptor of the modifier, stating that "each surgeon should report his/her distinct operative work by adding the modifier 62 to the single definitive procedure code." In short, modifier 62 applies for only one primary procedure and its related addon codes for each surgeon.

Treat each physician's portion as a separate procedure that requires a separate operative note, says BethThomsen, department billing coordinator at University of Toledo Physicians LLC in Toledo, Ohio. The sum of these two op notes equals the one CPT code both physicians are submitting.

You should be careful to know when modifier 62 applies to the code you wish to report, says Stephanie Collins, CPC, healthcare consultant with Gates, Moore & Company in Atlanta. Medicare won't pay for co-surgeries with just any code in the practice, so don't bother appending the modifier where it doesn't fit.

Check your Medicare physician fee schedule database to confirm that the procedure you wish to report qualifies for modifier 62. Otherwise, your surgeons cannot code and bill as co-surgeons for that procedure. To be eligible for payment, make sure that your procedure codes have either a Medicare co-surgery indicator of "1" or "2." The coverage dictates a pricing of 125 percent of the allowable, which is a 50-50 split between both surgeons or 62.5 percent for each surgeon.

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

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.

Example: Suppose your otolaryngologist and a neurosurgeon share a single approach and single CPT code for a main surgery. Both physicians should use the same code appended with modifier 62. Therefore, you and the neurosurgeon's coder should each submit 61530-62 (Craniectomy, bone flap craniotomy, transtemporal [mastoid] for excision of cerebellopontine angle tumor; combined with middle/posterior fossa craniotomy/craniectomy). This code carries a co-surgery indicator of "2."

Warning: Don't make the big mistake of unbundling a procedure that a single CPT code describes by a single CPT code and billing out one component for one surgeon and another for the second surgeon. Remember, the only way to report it is by appending modifier 62 to the single procedure for both surgeons.

Medicare will not allow modifier 62 for a procedure with a "0" indicator, which means that you are not allowed to bill for co-surgeons.

For instance, code 31239 (Nasal/sinus endoscopy,surgical; with dacryocystorhinostomy) contains a "0" in the co-surgery column. Thus, you will never be able to report modifier 62 with this code.

Bonus: You may find cases when you'd find a "9" in the co-surgery column. If so, Medicare will not consider modifier 62 applicable to this code, so don't even attempt appending it.

Other than the presence of indicator "2" in the cosurgery column, the AMA policy does not specifically state outright that both surgeons should belong to different specialties. You should, however, consider this the case.

Example: Two separate surgeons performed a distinct portion of the transsphenoidal removal of a pituitary tumor. The otolaryngologist performs the approach; the general surgeon performs the definitive procedure. The otolaryngologist would perform and dictate his part, then transfer the case and dictation to the general surgeon for the remainder of the procedure. You should code the otolaryngologist and general surgeon's services identically using 61548-62 (Hypophysectomy or excision of pituitary tumor, transnasal or transseptal approach, nonstereotactic).

Note: Check out the 2009 Otolaryngology Survival Guide by purchasing a subscription at https://www.aapc.com/codes/.