Question Two ophthalmologists did surgery on the same patient, two different surgeries. Help!!!

[mittens12h@gmail.com]

I have two doctors in the same practice who recently did surgery on the same patient on the same day. One did a catract extraction 66982, and the other did Ahmed. We have tried to get both paid and have used modifier -62 on professional and ASC claims. I need to know if both professionals need to have modifier -62 on them and the ASC, or is it just the professionals that need the modifier, or should just one professional claim have the modifier? The ASC we are using 66991 w/a modifier and are getting denied also. This is going to Medicare.

 

[amyjph]

62 is not used if they are performing two different procedures. In this case the surgeons dictate their own separate op notes and bill their own totally separate CPTs each on one claim. For the ASC, I am not 100% sure, but I think for a facility, they do one claim only with all the CPT done during the single op session because it was only one operative session/room.

https://med.noridianmedicare.com/web/jfb/topics/modifiers/62

"If surgeons of different specialties are each performing a different procedure (with specific CPT codes), neither co-surgery nor multiple surgery rules apply (even if the procedures are performed through the same incision). If one of the surgeons performs multiple procedures, the multiple procedure rules apply to that surgeon’s services."

Also, if you search the PFS for the CPTs, you will see co-surgery (62) is not allowed for those. https://www.cms.gov/medicare/physician-fee-schedule/search