Billing modifier 62 and 80 for three surgeons

MaryDx

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For CPT 22558 surgeon #1 performs the anterior approach and has an assistant surgeon, and surgeon #2 performs the spinal surgery. Can the following be billed?

Surgeon #1 22558 mod 62
Assistant to #1 Surgeon 22558 mod 80

Surgeon #2 22558 mod 62

Or is there an industry standard that states a co-surgeon can't have an assistant surgeon who is not the other cosurgeon.

Thank you!
 

thomas7331

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In my experience, most payers' policy is that they won't pay for both an assistant and a co-surgeon for the same procedure, but it's a pretty unusually situation so you never know how they'll handle it. CMS policy is that "If A/B MACs (B) receive a bill for an assistant surgeon following payment for co-surgeons or team surgeons, they pay for the assistant only if a review of the claim verifies medical necessity." So if your documentation is good that the assistant was necessary, you might be able to get the payment if you submit the notes with the claim or appeal if it is denied.
 

MaryDx

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Location
Lakeview, OR
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In my experience, most payers' policy is that they won't pay for both an assistant and a co-surgeon for the same procedure, but it's a pretty unusually situation so you never know how they'll handle it. CMS policy is that "If A/B MACs (B) receive a bill for an assistant surgeon following payment for co-surgeons or team surgeons, they pay for the assistant only if a review of the claim verifies medical necessity." So if your documentation is good that the assistant was necessary, you might be able to get the payment if you submit the notes with the claim or appeal if it is denied.


Thank you!
 
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