coding help - plastic surgeon

lalalisa

Contributor
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13
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Haydenville, MA
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I code for a general surgeon and a plastic surgeon. My surgeon did a mastectomy(19303) and the plastic surgeon assisted and then did immediate breast reconstruction(19367). Do I need to bill with any modifiers? I billed as follows:

19303-62-surgeon
19303-80-assist plastic surgeon
19367-62-plastic surgeon

Insurance is denying 19303-62 as a code that doesnt require cosurgeon. I maybe misunderstanding the 62 modifier. If the surgeon opens and does her procedure and the plastic surgeon then does her procedure and then closes, do I need to bill with any modifiers? The payment for each should be reduced because one opens and the other close? Please help. Thanks
 

cmartin

Guru
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You only use the -62 when each surgeon is doing part of a single procedure - for instance, if they were doing different parts of the 19303. If they're each doing a different procedure, for which there is no "combo" code - and there's none that encompasses both a mastectomy & the reconstruction - then they each bill their own code w/o the modifier. If the plastic surgeon assisted the general surgeon on the mastectomy, he/she can also bill the mastectomy code with the -80, in addition to the reconstruction code. They don't use the -62 when they do different procedures during the same operative session, only when they jointly perform the SAME procedure(s).
I hope this isn't clear as mud -
Connie
CPC-GENSG
 
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