Practice Management Alert

Question: Our gastroenterologist recently performed a PEG tube placement with the help of another surgeon. I am trying to file the claim with modifier 62 (Two surgeons), but I have never used the modifier before, so I am a little wary. What should I keep in mind when filing a claim with modifier 62?


Michigan Subscriber

Answer: The first thing you should do is report 43246 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with directed placement of percutaneous gastrostomy tube) for the PEG tube placement. Then ask yourself:

- Does each surgeon have his own notes? When acting as co-surgeons, two physicians cannot share the same documentation. Have each physician provide a note describing what portion of the procedure he performed, how much work was involved, and how long the procedure took.

- Does each surgeon note the co-surgeon in his documentation? Make sure that both of the doctors involved in the co-surgery identify the other as a co-surgeon. In order for your modifier 62 claim to succeed, both physicians must submit claims for the same procedure, and both physicians must use modifier 62.

- Are each surgeon's diagnosis codes and procedure codes identical? Co-surgeons need to report the same diagnosis code(s) and CPT code(s). You can make sure the codes line up by having someone check both claims before sending them out to the payer.

If you can answer -yes- to all of these questions, you-ve got an acceptable claim; attach modifier 62 to 43246 to show that it took two surgeons to perform the procedure.

The answers to the Reader Questions were provided and/or reviewed by Catherine Brink, CMM, CPC, president of HealthCare Resource Management Inc. in Spring Lake, N.J.