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2 surgeons, 2 knees

  1. #1
    Question 2 surgeons, 2 knees
    Medical Coding Books
    We have a situation where 2 ortho surgeons did total knee replacements on one patient at the same op session. One on each knee. Does this require the 62 modifier or the 50 modifier? Or would modifier 66 be suffi-cient? They are in the same clinic(same tax id#). I don't feel modifier 58 would work, but what about 59?
    Last edited by pcheshier; 05-26-2010 at 08:50 AM.

  2. #2
    Are they from the same practice (same tax id)? 27447 does not qualify for a 62 modifier so your claim would be denied. As for the 66-that is usually physicians a different specialities and more complex cases. My thought is if same practice you could append a 58 modifier on the 2nd claim.

  3. Default
    I would not use modiifer 58, that is not appropriate. Our office has this situation come up and we always try to get the insurance company to pre approve both surgeons, so each gets paid at 100% of the allowable fee. If pre approval is not obtained, since it is too separate surgeons, each should submit a separate claim for their portion of the surgery with the modifier RT/LT attached to appropriate charge.

    Expect re imbursement of 100% first claim and then 50% second claim.

  4. #4
    Milwaukee WI
    Default They shouldn't BOTH get 100%
    They shouldn't both get 100% in any case because the patient did not have both surgeons performing pre- and post-operative care. One of them should only get 50%.

    I would code the surgeon who is the primary surgeon with the procedure, and surgeon # 2 with procedure -59 modifier. You will probably get a denial for duplicate in any case, and they you can submit both op reports and a letter of explanation. There should be a medically necessary reason why two surgeons did this rather than one surgeon operating on both knees. (Perhaps patient had co-morbidities that required you to limit anesthesia time?)

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

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