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Gyn surg help!

  1. #1
    Location
    Chicopee, Mass
    Posts
    75
    Default Gyn surg help!
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    One of my docs went into the OR and did a diagnostic pelviscopy for pelvic pain. The patient had an inflamed appendix, so another doc outside of our group did the appendectomy. How am I going to bill for this? I was going to just bill for the DX pelviscopy, but won't the ins co reject since another surgeon will be billing out for the appendectomy? Anyone have any ideas here???

  2. #2
    Default
    could you bill as a co-surgery?
    Anna Weaver, CPC, CPMA, CEMC
    Associate Auditor

  3. #3
    Location
    Chicopee, Mass
    Posts
    75
    Default
    That is what I was thinking... even though my doc did not do the appendectomy part?

  4. #4
    Default
    My understanding is as long as they both participated, they both were involved in specific parts of the surgery, they both should be able to bill it. They will both have to do an OP report, and I usually coordinate with the coders at the other office to make sure we are all on the same page. You will both bill the same code and add a 62 modifier. But, fortunately, I haven't had a problem with any of the offices I have worked with before.
    Good luck.
    Anna Weaver, CPC, CPMA, CEMC
    Associate Auditor

  5. #5
    Location
    Chicopee, Mass
    Posts
    75
    Default
    Thank you very much for your help!

  6. Default
    Each physician bills only for the portion they peformed. Your doc would bill for the diagnostic (was this laparoscopy)...and the other doc bills for the appendectomy. Co-surgeon would only be billed if both docs did both procedures and both dictated etc.....

  7. #7
    Location
    Milwaukee WI
    Posts
    4,466
    Default Co surgery
    Please read the description in Appendix A of CPT for Modifier 62 (I'm at home and without my book right now, so I can't quote it for you).

    It specifically states that when two surgeons each perform a unique part of a procedure then they should both code the procedure with the -62 modifier.
    So it does NOT require that both surgeons are both in the operating suite for the entirety of the procedure.

    That being said, I think in this case you MAY be ale to bill each surgeon individually for the portion s/he performed. I do not think that a pelviscopy is a usual part of an appendectomy, so I do not think it would be unbundling to each code.

    Like I said I'm at home and without all my resources, so I may be incorrect.

    F Tessa Bartels, CPC, CEMC

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