Results 1 to 7 of 7

Modifier 62 - the reimbursement breakdown

  1. #1
    Location
    Long Island/New York
    Posts
    1,271
    Default Modifier 62 - the reimbursement breakdown
    Exam Training Packages
    Does anyone know the breakdown of Modifier 62 (i.e. what is the reimbursement breakdown, surgeons assisting each other from separate practices, etc.) One of my Dr's office managers asked me and I never had to answer this type of question so I want to make sure I have it corect. Thanks.

  2. #2
    Location
    North Carolina
    Posts
    3,126
    Default
    For co-surgeons (modifier 62), the fee schedule amount applicable to the payment for each co-surgeon is 62.5 percent of the global surgery fee schedule amount.

    http://www.cms.hhs.gov/manuals/downloads/clm104c12.pdf

    Section 40.8 B

  3. #3
    Location
    Milwaukee WI
    Posts
    4,466
    Default Assist is NOT modifier -62
    However, if one surgeon is acting as an assistant to another sugeon, then the assistant surgeon uses the -80 (or -82) modifier. Only the primary surgeon needs to dictate an operative note, in which the assistant surgeon is identified and a description of the assistance given is included.

    If they are truly co-surgeons (each performing a distinct portion of a complete procedure), they they each append the -62 modifier on the CPC code (both should be using the exact same code), and they each much dictate their own operative report.

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

  4. #4
    Location
    Long Island/New York
    Posts
    1,271
    Default
    Quote Originally Posted by FTessaBartels View Post
    However, if one surgeon is acting as an assistant to another sugeon, then the assistant surgeon uses the -80 (or -82) modifier. Only the primary surgeon needs to dictate an operative note, in which the assistant surgeon is identified and a description of the assistance given is included.

    If they are truly co-surgeons (each performing a distinct portion of a complete procedure), they they each append the -62 modifier on the CPC code (both should be using the exact same code), and they each much dictate their own operative report.

    Hope that helps.

    F Tessa Bartels, CPC, CEMC
    Tessa-
    Thanks. What is the reimbursement on a surgeon that is only an assistant? Are there any guidelines that need to be followed when billing out an assistant surgery?

  5. #5
    Location
    Milwaukee WI
    Posts
    4,466
    Default Assistant Surgeon reimbursement
    Reimbursement varies with your payer ... typically 18-20% of the allowable for the primary surgeon.

    The primary surgeon dictates the operative report, listing the assistant surgeon (could be another surgeon, a PA or NP) and some description of the assistant's role in the surgery. If you are in a teaching hospital and dealing with a government payer (Medicare or Medicaid), you must have a statement to the effect that "no qualified resident was available and so Dr X assisted."

    If the two surgeons are NOT in the same practice and don't have access to each other's operative reports you will have to coordinate with the other surgeon's staff to get a copy of the note(s) and to ensure that they are in agreement with the coding (especially if you are using -62 co-surgeon modifier).

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

  6. #6
    Default
    For Medicare it is 16% if the assistant is another MD/DO and 10.4% if the assistant is a NP/PA.

    Laura, CPC, CEMC

  7. #7
    Location
    Long Island/New York
    Posts
    1,271
    Default
    Thank you both!! Funny there was an article in the Coding Edge magazine this month. Read it over the weekend which really helped.

Similar Threads

  1. Replies: 2
    Last Post: 09-18-2015, 02:17 PM
  2. Modifier 59 vs Modifier 91 for Laboratory
    By leahrey in forum Modifiers
    Replies: 1
    Last Post: 06-23-2015, 01:01 PM
  3. MODIFIER PT VS MODIFIER 33 Screening Colonoscopy
    By Ann Johnson in forum Modifiers
    Replies: 2
    Last Post: 07-19-2012, 08:08 AM
  4. Modifier 58 versus Modifier 78
    By Ramona03 in forum Medical Coding General Discussion
    Replies: 2
    Last Post: 06-04-2012, 01:10 PM
  5. Modifier 51 Versus Modifier 59
    By Sborkowski in forum Modifiers
    Replies: 3
    Last Post: 05-26-2009, 04:59 PM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •  
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?

Login

Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.