Wiki B/L TKR by 2 surgeons

[bprimavera]

Patient had B/L TKR performed together. Dr. A was the primary surgeon on the left knee and assistant surgeon on the right. Dr. B was the primary surgeon on the right knee and assistant surgeon on the left. Patient has federal Medicare and they have not accepted billing unilaterally; denial states they require a -50 modifier. However, a -50 would be inappropriate because Dr. A would be billed as primary for both left and right and Dr. B would be billed as the asst on both sides, which is not accurate.

I was told I was wrong when I said I would bill it unilaterally and appeal it later with medical documentation so now I'm stuck on how to get these procedures out.

Any insight would be helpful! Thanks in advance!!

 

[thomas7331]

I agree with you that it cannot be billed with modifier 50. I would take it to a second level of appeal and make sure you include a clearly worded letter explaining the situation. At the first level of appeal, the reviewers do not always look at these things very carefully.

 

[bprimavera]

I agree with you that it cannot be billed with modifier 50. I would take it to a second level of appeal and make sure you include a clearly worded letter explaining the situation. At the first level of appeal, the reviewers do not always look at these things very carefully.

I was advised by someone else to bill them b/l as co-surgeons. Thoughts on that approach?

 

[thomas7331]

I was advised by someone else to bill them b/l as co-surgeons. Thoughts on that approach?

No, they are not co-surgeons if they are working on separate procedures. In addition, I believe that Medicare will generally consider co-surgeons medically necessary only when the two physicians are of different specialties.