Wiki Assistant Surgeons and Co-surgeons together

[RachelH30]

I code for urology, and have a radical nephrectomy surgery case where two of our MD's performed the nephrectomy together, one was primary, and the other the assistant surgeon. This is what we often see, and will add modifier 80 to the assistant surgeon, however, the patient had some aortic bleeding and a vascular surgeon was also involved in the case, so from a different specialty. I do not know the rules or guidelines on coding for co-surgeons, when there was also an assistant surgeon from our specialty involved in the case.

Normally we would code the CPT code for the primary surgeon, and then code the CPT again for the assistant surgeon with modifier 80.
since there was also a co-surgeon involved from a different specialty, would we add modifier 62 to the primary surgeon's CPT to support the co-surgeon or is this not allowable when an assistant is also involved; does that "overrule" the assistant surgeon in this case?

 

[cgaston]

Was the aortic bleeding a direct result of the nephrectomy? (e.g. because of an invasive tumor)


If it was unrelated to the nephrectomy (e.g. an iatrogenic injury) the vascular surgeon would bill for his/her services separately from your physicians so no co-surgeon modifier would be needed.

 

[thomas7331]

Agreed, this does not sound like a co-surgeon situation. Co-surgeon billing is for cases where a single procedure requires the expertise of two surgeons from different specialties and both are involved in the full procedure and both must bill the exact same code. (As an example, one of the most common of these is the endoscopic placement of a PEG tube, 43246, which requires the gastroenterology's skill for the endoscopic portion and the general surgeon's for the incision through the abdominal wall.) An assistant is not separately payable in a co-surgeon procedure under most payer policies. If the second physician is performing a different procedure than the primary surgeon, that is not a co-surgery, and they would each bill for what they actually did.