Wiki Breast reconstruction; TRAM w/co surgeon (19364)

[NPSDEB]

I did a search on procedure code 19364 for this thread and it looks like this question goes way back. We have had a few insurance companies deny the co-surgeons (62 modifier) for procedure code 19364 stating they are not of different specialties (two board certified plastic surgeons doing the case together). This is a lengthy procedure and to reduce anesthesia time; each surgeon performs the surgery on one side of the body. What is everyone's experience on getting this paid. Mine is all over the board! Of course, every claim needs to be appealed and explained as to why it needs two surgeons. We were wondering if each surgeon should just submit which side of the body they did (Dr A reports 19364.RT and Dr B reports 19364.LT... no 62 modifier?)

If you would rather contact me direct my email is dmiller@northlandplasticsurgery.com

Thank you-
Deb

 

[cambry]

Did you ever get information on this? I am wondering as well

 

[JulieRamone]

I did a search on procedure code 19364 for this thread and it looks like this question goes way back. We have had a few insurance companies deny the co-surgeons (62 modifier) for procedure code 19364 stating they are not of different specialties (two board certified plastic surgeons doing the case together). This is a lengthy procedure and to reduce anesthesia time; each surgeon performs the surgery on one side of the body. What is everyone's experience on getting this paid. Mine is all over the board! Of course, every claim needs to be appealed and explained as to why it needs two surgeons. We were wondering if each surgeon should just submit which side of the body they did (Dr A reports 19364.RT and Dr B reports 19364.LT... no 62 modifier?)

If you would rather contact me direct my email is dmiller@northlandplasticsurgery.com

Thank you-
Deb

Modifier 62 is appropriate. In my experience, having 2 surgeons just to expedite the OR time does not support medical necessity. There are transplant cases and brain surgery cases that take longer, performed by one surgeon. In the past, I have had doctors ask to appeal, which I have, but to no avail. There needs to be a medical reason why co-surgeons were needed. Trying to be expeditious is not a medical reason. Was the patient unable to undergo anesthesia for more than X hours? If so, this needs to be clearly documented. Ideally, all surgeons try to be thorough and expeditious in the OR. Why is this case any different? Each provider billing their own is inappropriate, as this is 19364-50 so the two surgeons both did their own work on the bilateral procedure. I would bill 62 to each. You can try to appeal, but I success is rare.