Muptiple Modifier Question Co-Surgeon then Non-Cosurgen Charges Modifier 51

coffee2day

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Hello,

When billing for mixed co-surgeon charges and non-cosurgeon charges in the same session/claim, does the non-cosurgeon charges start at 100% fee?

Example -
35226 repair bl ves direct lower ext modifier 62
34825 AAA repair modifier 62/51
+34826 additional vessel extension modifier 62
75953 s&i for vessel extension mod 26
36200 Aorta Selective Cath (non-cosurgeon charge) - Does this code get billed out at 100% fee or do I put mod 51 on this to reduce?

Thank you!
 
Messages
812
Best answers
0
Hello,

When billing for mixed co-surgeon charges and non-cosurgeon charges in the same session/claim, does the non-cosurgeon charges start at 100% fee?

Example -
35226 repair bl ves direct lower ext modifier 62
34825 AAA repair modifier 62/51
+34826 additional vessel extension modifier 62
75953 s&i for vessel extension mod 26
36200 Aorta Selective Cath (non-cosurgeon charge) - Does this code get billed out at 100% fee or do I put mod 51 on this to reduce?
I can maybe offer some help... maybe.

So first thing, I'll just assume the example's use of mod 62 meets all of the billing requirements and criteria for "co-surgeons".

The one thing that immediately caught my eye was +34826-62. You should never put modifiers on add-on codes because whatever mods are put on the primary code will carry-over to the add-on code. So in your example, +34826 should be modifier free, not with the 62. The basic idea is that if a co-surgeon participated in 34825, he/she obviously would be participating with the add'l vessel. +34826.

Now, here's where I'm going off what the CPT book says, so don't quote me on it. But paraphrasing, code 34825, +34826 are in a code range that reports placement of a graft for AAA repair.... Then it goes on to say "Introduction of guide wires and catheters should be reported separately (eg, 36200)." and then "Extensive repair or replacement of an artery should be additionally reported (eg, 35226)." Later in the guidelines it mentions to also bill the 75953.

So, how I understand that is that the codes you have in the example should all be reported per the CPT guidelines and I wouldn't put a 51 mod on anything - this is largely because the text reads like each code is a distinct portion that needs to be reported to complete the picture. I could be wrong, but that's where I'd go if I were doing it myself.

Ultimately, if it were me, I'd end up with -
Claim 1: 35226-62, 34825-62, +34826, 36200, and 75953-26 (depending on which surgeon did this).
Claim 2: 35226-62, 34825-62, +34826

If I'm correct, which I honestly am not sure, then reimbursement would be -
Claim 1: 35226 at 62.5% of fee schedule, 34825-62+34826 at 62.5% of fs, 36200 100% of fs, and 75953-26 at 100%
Claim 2: 35226 at 62.5% of fee schedule, 34825-62+34826 at 62.5% of fs

I'm 100% sure on the add-on/no modifier rule. But everything else... that's my two cents.
 
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