Wiki multiple procedure reduction

[clgrn1@gmail.com]

When two surgeons from the same medical group, (using the same tax ID Number) operating simultaneously on contralateral breasts, performing identical procedures, is this considered one procedure with multiple reductions or is each surgeon entitled to a primary procedure with multiple surgical reduction? example: CPT code 19370 (R), 11970 (R), 19370 (L), and 11970 (L)

clgrn

 

[PLAIDMAN]

I know Medicare wants to see 50, 62, bilateral, co-surgeons, but I have some commercial payors who want 59, lt or rt, on second surgeon.

But yes they are each primary surgeons for their respective breasts. I believe the 62 pays at 150% to be split by each surgeon, and then reductions on the multiple procedures.

 

[FTessaBartels]

62 modifier

If the procedure code accepts the -62 modifier, that would be the appropriate way to code. Each surgeon will receive 62.5% of allowable (total of 125% of allowable to the practice).

If the procedure does not accept the -62 modifier, you can code for each surgeon separately, with a -59 modifier on one.

Be prepared for a "duplicate" denial and to appeal with operative notes.

Hope that helps.

F Tessa Bartels, CPC, CEMC