Wiki Using Modifier -62

[catharine]

Hello All,
I have two doctors same specialty same sub-specialty, they want to do co surgery's (-62) with each other. As i understand it from Medicare that two surgeons from same specialty/sub-specialty can not bill as co surgeons. Is this correct? Can they switch as primary physicians during a procedure for example: Hysterectomy and a colpopexy. Dr A dose the hysterectomy as primary and Dr B does the Colpopexy as primary. Can Dr A and B bill as co-surgeons? Can they also bill as assistants to each other at the same time? I think no, but they keep asking and if there is any documentation you can direct me too that would be great. Thank-you!!

 

[thomas7331]

You're correct - two physicians of the same specialty working together on a surgery would not be considered co-surgeons. But they can assist each other in separate procedures done in the same operative session (assuming the procedures allow for an assistant and none of the procedures bundle into another), and it is fine for each to be primary on one procedure and assist with another, as long as documentation supports this.

As an example, one situation I've come across on occasion is two orthopedic surgeons performing bilateral joint replacements where each will be the primary surgeon on one side of the body, and each will also be the assistant to the surgeon working on the opposite side, which you'd see billed like this:

Dr. A:
27447-RT
27447-LT-80

Dr. B:
27447-LT
27447-RT-80

 

[SharonCollachi]

Co-surgeons: When two or more surgeons with different specialties submit claims for the same operative session for the same beneficiary and same date of service, all providers must use the co-surgeon modifier.When two different providers bill the same CPT code, same patient and same date of service and one of the providers bills with modifier 62, the other provider must also bill with modifier 62. Note, however, that modifier 62 may only be used when the co-surgeons are of different specialties and are working simultaneously.


This document is here.

______________________________________________________________________________________________________________________

Medicare pays for a surgical assistant when the procedure is authorized for an assistant and the person performing the service is a physician, physician assistant (PA), nurse practitioner (NP) or a clinical nurse specialist (CNS).To facilitate payment, CMS (under authority of 42 CFR Section 414.40) has established uniform national definitions of services, codes to represent services, and payment modifiers to the codes, to include the use of payment modifiers for assistant at surgery services.To bill for these services, you should use Modifier 80 (assistant surgeon), 81 (minimum assistant surgeon), or 82 (when qualified resident surgeon not available). You should also use Modifier AS when you need to indicate that a PA, NP or CNS served as the assistant at surgery. Be aware that when you use Modifier AS, you must also use Modifier 80, 81, or 82 because using these modifiers without modifier AS indicates that a physician served as the surgical assistant. Claims that you submit with modifier AS and without modifier 80, 81 or 82 will be returned to you.
Here is that document.

 

[csperoni]

Co-surgeons: When two or more surgeons with different specialties submit claims for the same operative session for the same beneficiary and same date of service, all providers must use the co-surgeon modifier.When two different providers bill the same CPT code, same patient and same date of service and one of the providers bills with modifier 62, the other provider must also bill with modifier 62. Note, however, that modifier 62 may only be used when the co-surgeons are of different specialties and are working simultaneously.
This document is here.
______________________________________________________________________________________________________________________
Medicare pays for a surgical assistant when the procedure is authorized for an assistant and the person performing the service is a physician, physician assistant (PA), nurse practitioner (NP) or a clinical nurse specialist (CNS).To facilitate payment, CMS (under authority of 42 CFR Section 414.40) has established uniform national definitions of services, codes to represent services, and payment modifiers to the codes, to include the use of payment modifiers for assistant at surgery services.To bill for these services, you should use Modifier 80 (assistant surgeon), 81 (minimum assistant surgeon), or 82 (when qualified resident surgeon not available). You should also use Modifier AS when you need to indicate that a PA, NP or CNS served as the assistant at surgery. Be aware that when you use Modifier AS, you must also use Modifier 80, 81, or 82 because using these modifiers without modifier AS indicates that a physician served as the surgical assistant. Claims that you submit with modifier AS and without modifier 80, 81 or 82 will be returned to you.
Here is that document.

I had to re-read the second portion several times, not believing the last 2 sentences regarding NPP as assistants. I have been billing PA surgical assists for 15+ years with -AS and never needed to ALSO use -80, 81 or 82. Then I realized those instructions are for CAH facilities that the assistant has reassigned billing rights to the CAH. It's not really the original question posted, but I would note PA/NP/CNS assisting at surgery would use just -AS for typical professional billing. Physicians would use -80, 81 or 82 only.

Regarding the original question, I agree with both Thomas & Sharon that this cannot be billed -62 if the providers are the same specialty/subspecialty. For example, in my world, sometimes a gynecologic oncologist is called into the start of a surgery by a general ob/gyn for an incidental suspicion of cancer. If the entire procedure done by both physicians is best represented by 1 code (and both docs dictate their op note), that can be billed co-surgeons since they are different sub-specialties. If both of my gyn oncs do a case together, then I must bill as primary and assist with -80 or -82.

 

[catharine]

Thank you all. I keep telling my doctors that they can not bill as co-surgeons no matter how they dictate, but they are continuously unsatisfied with my answer so keep pressing. Ill try again. thanks all