Two procedures two doctors mod 52?

Mike Greer

Guest
Messages
11
Location
Johnson City, TN
Best answers
0
If Dr Bill from another practice opens a patient and performs a surgery and before he closes my doctor steps in and using the same incision performs a seperate surgery on a differant body system. He then steps out and the first doctor closes.

Since my doctor didn't open or close (which is included in the package) do I code the whole procedure or do I have to use a 52 modifier?

Thanks
Mike:eek:
 

kevbshields

Guest
Messages
1,101
Location
Louisville, KY
Best answers
0
Wow, good one.

I think I'd code the CPT representative of the actual service and append a -52.

Here's my next question: who's doing post-op followup for both surgeries? Each doc. sort of taking care of his/her own or what? If you have the ability to look ahead at that prospect, I think you could get away with reporting -54/55 etc in lieu of the -52. Probably not an option though.

(I think Mod-66 is too far out there to be appropriate in this instance. Let me say that I have no experience using '-66, so perhaps that's why I'm overlooking it; just doesn't quite seem to fit. Of course, you've got the Op Report. )

Well, good luck. Hope this helps some.
 

AnthonyBush

Guest
Messages
24
Location
Louisville, KY
Best answers
0
I think, from a payor perspective of course, that a modifier of -54 would be more appropriate in this instance.
Modifier -54 states, "Surgical Care only: When one physician performs a surgical procedure and another provides preoperative and/or postoperative management.

Didn't the first Provider do a totally different procedure and the 2nd Provider do another?

The first Provider did both the pre-op and post-op care on the patient. The 2nd provider would need to add the -54 modifier.
 

AnthonyBush

Guest
Messages
24
Location
Louisville, KY
Best answers
0
In addition....the opening and closing of a patients surgical entry site is usually inclusive to the procedure performed. The modifier -54 is telling us what the second provider did more in detail.

modifier -52 makes me think that there was only one surgery on the DOS, with no other Physician present.

Any feedback would be greatly appreciated.

Thanks

Anthony Bush, CPC, CCP
Medical Records Review Coordinator
 

AnthonyBush

Guest
Messages
24
Location
Louisville, KY
Best answers
0
Mike,

If possible could you have more information on this? I've been thinking and need some more details.

What was the procedure of the 1st surgeon? Will the 1st surgeon be doing the pre-op and post-op care for both procedures or just his?

What was the procedure of the 2nd surgeon who just went in and done his procedure and back out...using the same incision? Will the 2nd surgeon be doing any post-op care?

Please, if possible send as much information as possible. Thanks in advance...this looks to be a great discussion. Mr. Shields and I have been talking concerning this and would appreciate more information.

Anthony Bush, CPC, CCP
Medical Records Review Coordinator
 

xlbctso

Networker
Messages
50
Best answers
0
Modifier 66 would not be appropriate since this is really not team surgery. Nor is it co-surgery, modifier -62.

There really is no reason why you can't code the claim with both 54 and 52, as most payers (Medicare included) accept multiple modifiers. Many will accept anywhere from 3-4 modifiers (although typically the first two are used in pricing and adjudication).

If you use modifier -54 as the first modifier, you are letting the payer know you only performed the intraoperative portion of a procedure. Modifier 52 will let them know this is a reduced procedure in that you did not need to perform the opening or closing - the payer may or may not discount their fee upon review. You will need to send documentation to explain the reduced portion of the procedure.

Who is actually following up on the patient?

Louise
 

Mike Greer

Guest
Messages
11
Location
Johnson City, TN
Best answers
0
Hi guys,

OK.... the surgeries are normally like a hysto (gi) and our (gu) steps in and does a TVT for prolapse of pelvic floor, or stress incont. Our Doc may or may not do a follow up, but the other does post management.

Or.. a gi cuts ureter and our gu setps in and repairs the ureter and steps out. Again.. may or maynot follow up depending on symptoms post opp.

Thanks
Mike
 

Mike Greer

Guest
Messages
11
Location
Johnson City, TN
Best answers
0
I was thinking the 52 due to not opening or closing, the other Doc would bill a complete procedure as his was complete. The 54 with the 52 sounds right if no post opp managment.

Mike
 

AnthonyBush

Guest
Messages
24
Location
Louisville, KY
Best answers
0
Mike thanks for the additional information. I think your Doc...the one going in after the patient was already opened should bill with a modifier of -52..
Yesterday I was thinking of the other physician...I think...oh well that was yesterday...Just be sure and include in the documentation..the reason why your Doc is reducing his services.

Anthony Bush, CPC, CCP
Medical Records Review Coordinator
 

phnave

New
Messages
1
Best answers
0
Why wouldnt a modifier 80 or 81 be appropriate? Does your MD list the primary surgeon as assistant on his OP note? I would think that your doc would bill his portion as primary and the other MD would bill with an 80 or 81, depending on his/her level of involvement. The insurance company would reduce from there.

In response to the 54 modifier, most of the urologists that I've worked with do post op care on a TVT or a nicked ureter and this modifier wouldnt be appropriate.

Any other opinions out there???
 

dhorn

New
Messages
6
Best answers
0
I would think this would be considered co-sx in this case you would put a modifier 62. Please reply back if you disagree.
 

kevbshields

Guest
Messages
1,101
Location
Louisville, KY
Best answers
0
I'm not sure you may classify another surgeon as "assistant" when he/she is actually performing a unique service (that just happens to be timed in accordance with another procedure) unrelated to the initial service. I would seriously question that.

After all, I do not believe the requirement for assistant surgeon are met in this scenario. Think of this as you would a Pathology Consult done during a surgery--the Pathologist's services do not require Mod-80, simply because he/she consulted during another physician's operative session. The Pathologist's (and in this case, the Urologist's) services are separate, unique and distinctive from the primary procedure.

As I stated previously, Mod-54 is not likely to be appropriate, but under the stated circumstances in Appendix A, is possible.
 
Top