Question Modifier 62

Cmdella

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Hi all,

I need some help with co-surgeon billing. Our orthopedic doctors have been doing surgeries together and want me to bill them as co-surgeons. I was under the impression that co-surgeons have to be of different specialties. One of my docs thinks it's ok if they have different subspecialties but I can't find any documentation to back that up. I feel like I'm finding conflicting information.

For example, if two of my docs perform an Achilles repair (27650) on the same patient, same site, same session, do they each have to perform a different part of the procedure? Can surgeons of the same specialty bill as co-surgeons?

Any help is appreciated.
 

thomas7331

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Medicare does state that their co-surgery payment rules apply for 'two-surgeons, each in a different specialty'. I believe that most other payers follow this policy as well. Also, co-surgery fees are only typically allowed for procedures that actually require different specialties, such as a PEG tube placement which requires both surgical and endoscopy skills. For procedure 27650 that you've mentioned above, this would not usually be the case, and in fact, Medicare has assigned a co-surgeon indicator of '1' to this code which means that "supporting documentation is required to establish the medical necessity of two surgeons for the procedure". So even with multiple specialties, in order to obtain be eligible for co-surgery reimbursement, the records would need to show that the procedure was of a complexity such that two surgeons were medically necessary (for example if the tendon injury had neural or vascular involvement that might require a different specialty).

I would question whether your physicians are really acting as co-surgeons, or rather that one physician is there to assist but that they are dividing the work equally. I'd also just make a note that difference between billing as co-surgeons and as a surgeon with a physician assisting is pretty minimal. Co-surgeons receive 62.5% of the fee schedule each, which is a total of 125% of the fee. A physician assisting at surgery receives 16% of the fee from Medicare (and more from other payers), so the surgeon and assistant together are receiving 116% of the total fee. There's really not a huge financial gain here to billing procedures as a co-surgery, and you may want to point this out.
 
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