Wiki PLEASE HELP! 2 docs same specialty 2 surgeries

[ksrkelly7]

Hi there. I'm hoping someone can help me out. I have 2 general surgeons that each performed 2 SEPARATE operations following each other; not simultaneously. I have 2 separate OP reports. They assisted each other, not co-surgeons.

1st doc performed:

open roux-en-Y gastric with extensive lysis of adhesions (documented)

43846-22

after completion...

2nd doc performed:

open incisional hernia repair with bio mesh for component separation with bilateral subcutaneous flaps and abdominoplasty

49560
49568
15734-R
15734-L

Again this is a Medicare patient. PLEASE HELP!!

Thanks,

Kelly-CPC

 

[cgaston]

My first thought is to question why they used separate surgeons for these procedures.

Did the first surgeon close at the end of the case or leave the abdomen open for the second surgery?

Where is the incisional hernia? If they accessed the abdomen through the hernia for the first procedure the repair would be included in that service.

I would be very wary of trying to "get around" unbundling issues with Medicare.

 

[megg1100]

2 Surgeons

I would try modifier XP if the first surgeon left the suite. If he/she is still in the room, I would bill both with an 80.

-Megan, CPC, CIRCC

 

[ksrkelly7]

Thank you both for responding. Here are answers to your questions.

Both general surgeons specialize in different areas...one bariatric, one abdominal reconstruction.

Yes, the 1st surgeon left the abdomen open for the 2nd surgeon.

Yes, the incision was through the repair. I understand not coding for the hernia, but I believe the repair for component separation can still be billed. Instead of using CPT 49568 for the mesh, could CPT +15777, bio mesh, be used with 15734? It is biologic mesh.

No, the 1st doctor did not leave the suite after his case. He assisted the 2nd surgeon. My problem with using 80, is that they both assisted each other for the other's surgery. They were both long complicated cases. Is there a way for each surgeon to bill as primary for their individual surgeries?

 

[megg1100]

2 Surgeons

Honestly, since they aren't reporting the same procedure code, it probably doesn't need to be bypassed in the first place. However, if your primary procedure for the second physician includes work associated with opening the patient, you might want to add a modifier -52 since all components of the procedure were not performed. Usually at that point, Medicare will request the documentation and they can decide how they want to pay it.

Megan, CPC, CIRCC