Wiki Same Provider Group

[BS&SC]

Provider A is doing a 58571 with S2900. As provider A realizes there are many adhesions on the right, she takes care of transecting and ligating on the left and calls in Provider B from same group. Provider B takes over at console and does LOA, colpotomy, removes cervix and uterus through vagina. Provider A closes. How do I bill this? Break down into LOA, colpotomy and 58660 for Provider B, and 58571 with 52 for Provider A? This one had me stumped. The note from Provider B described himself as an intraoperative consult, but he obviously did way more than a consult. Should I suggest he change his participation to that of an assistant? My problem with that is Provider B is one of the providers who does not like to document or change anything.

I don't have the note in front of me, but any guidance would be nice.

 

[csperoni]

This to me (in reality) is more of a co-surgeon case. However, for billing guidelines, one of the requirements is physicians of DIFFERENT specialties (can be the same group). So if Dr. A is obgyn and Dr. B is gynonc or urogyn, then 58571-62 is most likely the best option. To try coding out 58660 with Dr. B and 58571 with Dr. A if the same group/specialty would be unbundling and incorrect coding. The op note by Dr. B does not have to say "I assisted".
If they are the same specialty, I would code
Dr. A 58571
Dr. B 58571-80 (or 81 if appropriate)
If they are different specialties, I would code
Dr. A 58571-62
Dr. B 58571-62
If same specialty, Dr. B is probably getting a bit shortchanged for the amount of participation, and Dr. A is getting a bit more credit than deserved. Some practices might have an internal way of balancing that out. Most practices I've come across would just call this "you win some, you lose some" since it's such a rare situation.

 

[tloeb]

This to me (in reality) is more of a co-surgeon case. However, for billing guidelines, one of the requirements is physicians of DIFFERENT specialties (can be the same group). So if Dr. A is obgyn and Dr. B is gynonc or urogyn, then 58571-62 is most likely the best option. To try coding out 58660 with Dr. B and 58571 with Dr. A if the same group/specialty would be unbundling and incorrect coding. The op note by Dr. B does not have to say "I assisted".
If they are the same specialty, I would code
Dr. A 58571
Dr. B 58571-80 (or 81 if appropriate)
If they are different specialties, I would code
Dr. A 58571-62
Dr. B 58571-62
If same specialty, Dr. B is probably getting a bit shortchanged for the amount of participation, and Dr. A is getting a bit more credit than deserved. Some practices might have an internal way of balancing that out. Most practices I've come across would just call this "you win some, you lose some" since it's such a rare situation.

This is very old but I have another scenario I was hoping to get some advice for. If Dr. A is a OBGYN and Dr. B is a Gen Surgeon from another practice (but same Health System) should they still bill at 58571-62 or is it appropriate for the Gen Surgeon to bill for the LOA when that is all the Gen Surgeon did?

 

[Cmama12]

This is very old but I have another scenario I was hoping to get some advice for. If Dr. A is a OBGYN and Dr. B is a Gen Surgeon from another practice (but same Health System) should they still bill at 58571-62 or is it appropriate for the Gen Surgeon to bill for the LOA when that is all the Gen Surgeon did?

In the large healthcare system where I work, true co-surgeries are not that common. I find that providers also may call someone a "co -surgeon" when they mean simply another surgeon involved, and not in the mod 62 sense. In your described scenario, which does occur frequently, the Gen Surg bills the lysis - usually enterolysis. Without seeing the notes, I don't think I would not bill the original example as a co-surgery either.