Wiki Co-Surgeon mod 62

[Cassi3434]

This is new to our facility and I've been trying to understand co-surgeon billing all day. I know that when billing mod 62, both surgeons needs to dictate their own operative reports. My doctor believe he should be able to bill the codes listed on the other providers operative report with mod 62, BUT my doctor did not dictate that he participated in those other procedures within his own operative report. Can I bill for the other procedures listed on the other physicians op with mod 62? Do you have any supporting documentation to support this so I can pass onto my provider? Thank you!

 

[Orthocoderpgu]

Frist of all, you are asking if you can bill for something that is not documented. A certified coder should never ask that question. If it's not documented, billing isn't supported. Usually with co-surgeons they perform different procedures: One will usually create the surgical access so another procedure can be performed by another provider. Keep in mind that not all CPT codes even allow -62. Have you verified that the procedures allow a co-surgeon? It sounds more like your provider "assisted", modifier -80. From my experience insurance companies like to review the documentation for modifier -62 because it's not used properly. Before billing this I would make sure that all op notes from all providers support the code, otherwise, they probably will not see any payment.

 

[csperoni]

As @Orthocoderpgu states above, you can never code and bill for something not documented.
IF there is documentation, there are several requirements to using -62.
1) CPT code must allow co-surgeons
2) Each physician provides their own op note specifying which portions they performed. The op notes should specify the other physician was co-surgeon
3) The 2 physicians are different specialties
4) Both surgeons must bill with -62
5) Each surgeon is primary for part of a procedure that is correctly described by one code
Based on the limited information you provided, it does sound more like your physician assisted. Or perhaps they were co-surgeons, but only for a specific procedure.
Here's an example from my world of gynecologic oncology.
Let's say a patient is scheduled for a vulvar biopsy and total hysterectomy with removal of tubes and ovaries.
Ob/gyn does the vulvar biopsy. Then removes an ovary with attached cyst and sends for frozen section while starting to remove the other tube/ovary and uterus/cervix. The frozen section comes back with a malignancy and the ob/gyn calls my doctor in. My doctor completes the hysterectomy and then also does pelvic and para-aortic lymphadenectomy. 58210 is for the radical hysterectomy with tubes and ovaries and lymphadenectomy.
Each physician dictates which portion they performed as primary. The ob/gyn would bill 58210-62 and 56605 for the vulvar biopsy.
Gynonc would bill 58210-62.
Even if the 56605 allowed -62 (it doesn't), it would be wrong for gynonc to bill that since they did not participate in it.
Now, there are plenty of times the ob/gyn might open a patient, then realized there is a high suspicion for malignancy and immediately call in gynonc. In those situations, the gynonc bills primary and the ob/gyn as assist.

 

[haraml7]

Did the provider assist in the surgery? In that case it would not be a co-surgery, depending on what type of licensure the provider has he could use 80 or AS modifier if he did not dictate his own note. So if they are different specialties, using different codes, you do not need a 62 modifier because they each did "Their" portion of the procedure and should warrant a separate payment, but the provider will need to dictate his own note for his portion. However, back to the assist at surgery, if he assisted in a surgery and its stated in one op note, that his assistance was needed then you can bill for his CPT code as an assistant. I would really need more information for this scenario, but just by what you posted you cannot bill for a 62 modifier because he didn't dictate his own note. The 62 modifier is not a "get out of dictating" modifier.

This is from CMS: https://www.cms.gov/outreach-and-ed...oducts/downloads/globallsurgery-icn907166.pdf

Claims for Co-Surgeons and Team Surgeons Under some circumstances, the individual skills of two or more surgeons are required to perform surgery on the same patient during the same operative session. This may be required because of the complex nature of the procedures and/or the patient’s condition. In these cases, the additional physicians are not acting as assistants-at-surgery. The following billing procedures apply when billing for a surgical procedure or procedures that require the use of two surgeons or a team of surgeons:
• If two surgeons (each in a different specialty) are required to perform a specific procedure, each surgeon bills for the procedure with a modifier “-62” (Two surgeons). Co-surgery also refers to surgical procedures involving two surgeons performing the parts of the procedure simultaneously, such as, heart transplant or bilateral knee replacements. Certain services that require documentation of medical necessity for two surgeons are identified in the MPFS look-up tool. NOTE: Some procedures require modifier “-62” and will be returned without payment if it is not used by both surgeons.
• If a team of surgeons (more than 2 surgeons of different specialties) is required to perform a specific procedure, each surgeon bills for the procedure with a modifier “-66” (Surgical team). Field 25 of the MFSDB identifies certain services submitted with a “-66” modifier which must be sufficiently documented to establish that a team was medically necessary. All claims for team surgeons must contain sufficient information to allow pricing “by report.” Global Surgery Booklet MLN Booklet Page 12 of 19 ICN 907166 September 2018
• If surgeons of different specialties are each performing a different procedure (with specific CPT codes), neither co-surgery nor multiple surgery rules apply (even if the procedures are performed through the same incision). If one of the surgeons performs multiple procedures, the multiple procedure rules apply to that surgeon’s services.

I hope that helps, let me know if you have any questions.

 

[toria11]

If two providers of the same specialty (and same practice) are working together to perform the same procedure simultaneously, they both still must have their own OP note in order to bill -62, correct? It is not enough for one to document using "we" and list the other as the co-surgeon.

 

[csperoni]

If two providers of the same specialty (and same practice) are working together to perform the same procedure simultaneously, they both still must have their own OP note in order to bill -62, correct? It is not enough for one to document using "we" and list the other as the co-surgeon.

One of the requirements for -62 is each surgeon must have their own op note.
Another of the requirements specified earlier in the thread is different specialties.
It sounds like in your scenario, one physician must bill primary and the other as assist. You will need to determine an internal way to split "credit" if that is a concern.