Appeal Letter to Support Cosurgeon 62165-62

[MsAnna]

Greetings all,
Does anyone have a standard appeal letter that they use for the denial of cosurgeons or any verbiage I can use to put one together? This is for a endoscopic pituitary case 62165-62

Thank you for any help you can provide.

Anna

 

[SharonCollachi]

The North American Skull Base Society has this to say about that procedure and co-surgeons:

Co-surgery (Modifier 62) When two surgeons participate in the procedure togethe performing different parts of the procedure, then each surgeon reports the same code with modifier 62 [Two Surgeons] for co-surgery. For example, in an endoscopic endonasal excision of a pituitary tumor case, the otolaryngologist (ENT) typically performs the approach and the neurosurgeon (NS) performs the tumor resection. Since neither surgeon performs the entire procedure him/herself, each physician reports 62165 with modifier 62 to reflect co-surgeon activities. Both surgeons document their service in an operative report listing the other as a co-surgeon. Each surgeon documents their own activity and refers to the other surgeon’s operative report for the portion(s) of the procedure that they did not personally perform.

Some surgeons choose to describe the entire operation in their own operative report including the portions of the procedure that they did not perform. This is acceptable as long as that surgeon’s operative report clearly delineates the portion that they personally performed and the two surgeons’ operative reports do not include conflicting information about the procedure. Neurosurgeons that perform the endoscopic endonasal excision of a pituitary tumor without assistance of ENT will report 62165 without the co-surgeon modifier (62) since they performed the global service.

Reimbursement Implications: In general, 62.5% of the payer fee is allowed for each co-surgeon using modifier 62. Both surgeons are then bound by payer postoperative global period guidelines; Medicare’s is 90 days.

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So, before you get to an appeal letter, did their documentation clearly show they were co-surgeons, what their specialities are (they have to be different), and what they each did? There are some appeal letters at the end of the document that the above comes from, here: https://www.nasbs.org/wp-content/uploads/2018/12/White-Paper-Final-with-Appendices.pdf

I think the appeal letters there are far too wordy. You have to keep it simple. Who, what, where, when, why.

 

[MsAnna]

Thank you so very much Sharon. I really appreciate you responding.

Anna