Wiki HELP! using modifier 62 and 80 on the same claim and getting denials

[kdarabaris]

Can anyone give feedback or help me find documentation on billing co-surgeon and assist on the same claim. In Appendix A of the AMA CPT book, modifier 62 states if a co-surgeon acts as an assistant in the performance of additional procedures, other than those reported with modifier 62, during the same surgical session, those services may be reported using separate procedure codes with modifier 80, as appropriate. If we are asked by another specialty to act as co-surgeon we of course bill with modifier 62 on primary procedures however since modifier 62 cannot be appended to instrumentation codes we bill with 80 on instrumentation. We are getting denials now from Horizon and Medicare on the instrumentation codes stating no qualifying base code is being used due to the the primary procedure being billed with 62 makes the TOS 2 and 80 makes TOS 8.
Example:
22551.62
22845.80
22552.62
20930.80


Thanks in advance.

 

[SydneyO]

20930 cannot be billed with modifier 62 or 80. The rest look correct though... maybe it's that one line item that's making it deny?

 

[kdarabaris]

20930 cannot be billed with modifier 62 or 80. The rest look correct though... maybe it's that one line item that's making it deny?

No any line with modifier 80 will deny payment as not billed with a primary procedure.

 

[Pam Warren]

Depending on your payer, you may not be able to bill co-surgery and assistant surgery by the same provider on the same claim. CPT allows it, but Medicare does not. You can bill one, or the other but not both. 22551 is your primary procedure, and 22845, 22552 are your add-on's, so they're billed appropriately from a CPT perspective. 20930 doesn't allow an assistant, so only your attending can bill that one.