Case Study:
Increase Reimbursement For Team Skull Surgery
Published on Sat Jan 01, 2000
When two surgeons work together to perform a complicated procedure, they bill the procedure codes with modifier -62 (two surgeons). But when each performs distinct aspects of the surgery that are unrelated, the modifier is unnecessary, allowing each physician to be reimbursed fully for the code billed.
The following operative session involved multiple procedures and repairs on a 68-year-old white male with a history of right-sided facial paralysis. He was found to have a malignant neoplasm involving the right parotid gland and right temporal bone. He now presents for a right lateral skull base procedure. Two physicians, an otolaryngologist and a neuro-otologist, performed the procedures. Both doctors dictated separate operative reports.
Diagnoses: Squamous cell carcinoma of the right lateral skull base (parotid gland and temporal bone); complicated open wound/defect ear and temporal bone.
Operations Performed: Preauricular infratemporal approach to the lateral skull base including right modified neck dissection; lateral skull base resection (parotidectomy) and right partial temporal bone resection; reconstruction of lateral skull base (using skin graft, abdominal fat graft and temporalis myogenous flap).
Procedures Performed
This operation involved a number of procedures described in separate op notes dictated by both physicians. The notes are too lengthy to be reproduced here, therefore a summary of the procedures performed is provided.
The first part of the procedure was the approach to the lesion. The otolaryngologist exposed the lateral skull base, allowing additional exposure of the parapharyngeal space and deep aspect of the parotid gland, pterygoid musculature and infratemporal fossa and lateral skull base. The otolaryngologist then identified, dissected and mobilized the internal jugular vein, spinal accessory nerve and occipital artery. This provided further exposure of the skull base.
Attention was then turned to the neck, where the otolaryngologist isolated the parotid gland and temporal bone. Resection of these structures followed.
The otolaryngologist then performed a modified neck dissection: (1) to help with exposure and approach to the right lateral skull base; and (2) to remove lymph nodes from the neck that were at risk for spread of metastatic disease from the malignant neoplasm in the parotid gland.
A neck dissection at different levels was completed.
At this point, the otolaryngologist turned his attention to the lateral skull base resection, where a cut was made superiorly down through the subcutaneous tissue, temporalis fascia and parotid gland at the level of the zygoma.
A partial lateral temporal bone resection was performed by the neuro-otologist. A conventional mastoidectomy was performed under high-power magnification after the neck dissection and radical parotidectomy. The microscope also was used during the resection of the lateral temporal bone to preserve the neurovascular structures and avoid injuries to them.
The otolaryngologist then started reconstruction by using a split-thickness skin graft [...]
