Wiki Bilateral procedures for CO-surgeons

[Rudolph.Dmello]

Hello,

What is the reimbursement methodology used when Bilateral procedures are billed for Co-surgeons?

Thanks,
Rudolph

 

[mhstrauss]

Hello,

What is the reimbursement methodology used when Bilateral procedures are billed for Co-surgeons?

Thanks,
Rudolph

Typically, reimbursement is increased by 50% for bilateral, reduced to 62.5% for cosurgeon.

So for a procedure that had a standard allowed fee of $1500.00, in theory, should be $1406.25, if both 50 and 62 mods are used.

I can't think of any cases that we would use both on the surgeries we perform, so I can't check EOB's to confirm that that's how the claims actually get processed.

HTH some!

 

[Rudolph.Dmello]

Thanks Meagan!

 

[mitchellde]

co-surgery is two providers performing distinct portions of the same procedure. Bilateral does not qualify; if each surgeon is performing the same procedure but on different sides, then each procedure is a distinct and separate procedure, not one procedure with different pieces being performed by two surgeons. So it should be billed as the procedure code with an RT modifier for one surgeon and an LT modifier for the other.