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-54 modifier with Assist or Co-surgery

  1. #1
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    Default -54 modifier with Assist or Co-surgery
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    If a surgeon who is on call is called into the OR to assist or perform co-surgery (depending on the documentation), and either an -80 or -62 is appended, do these modifiers also assume that this surgeon is responsible for "surgical care only", or would we also need to append the -54? In this case, the surgeon is of a different sub-specialty and also from a different practice, so the primary surgeon of record would be responsible also for the pre- and post-operative work. In my mind, that's the difference.

    Because the -54 modifier is related to decreased revenue (and I have a hot and heavy meeting coming up), I wanted to make sure I was thinking along the correct lines in suggesting that we also must append the -54, but I wanted to hear from others who might also have this kind of situation.

    Any links or references to regulatory guidance that speaks specifically to this scenario is appreciated.

    Thanks everyone and happy new year. Pam
    Pam Brooks, MHA, COC, PCS, CPC, AAPC Fellow
    Coding Manager
    Wentworth-Douglass Hospital
    Dover, NH 03820

    If you can dream it, you can do it. Walt Disney

  2. #2
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    Quote Originally Posted by Pam Brooks View Post
    If a surgeon who is on call is called into the OR to assist or perform co-surgery (depending on the documentation), and either an -80 or -62 is appended, do these modifiers also assume that this surgeon is responsible for "surgical care only", or would we also need to append the -54? In this case, the surgeon is of a different sub-specialty and also from a different practice, so the primary surgeon of record would be responsible also for the pre- and post-operative work. In my mind, that's the difference.

    Because the -54 modifier is related to decreased revenue (and I have a hot and heavy meeting coming up), I wanted to make sure I was thinking along the correct lines in suggesting that we also must append the -54, but I wanted to hear from others who might also have this kind of situation.

    Any links or references to regulatory guidance that speaks specifically to this scenario is appreciated.

    Thanks everyone and happy new year. Pam
    I think with the 80 modifier it is already assumed to be surgical care only since the provider is an assistant surgeon, and typically does not dictate their own op report.

    The 62 modifier means that both of the surgeons are considered primary and equally split 125% of the fee on the same global procedure. I don't think you can add a 54 modifier as that would change the character of the procedure.

    I could not find any specific documentation, maybe someone else has another opinion?
    Arlene J. Smith, CPC, CPMA, CEMC, COBGC

  3. Default
    I agree with your opinion Arlene. I couldnt find any documentation, but to me the 54 indicates that the surgeon is doing the entire surgery and surgery only alone. If they are assisting you would bill with 62, 82 or 80 whichever is appropriate because the reductions are already built in.

  4. #4
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    Quote Originally Posted by ajs View Post

    The 62 modifier means that both of the surgeons are considered primary and equally split 125% of the fee on the same global procedure. I don't think you can add a 54 modifier as that would change the character of the procedure.

    That's my point, I think. As co-surgeons, (which the op notes clearly convey,) they do split 125% of the global fee. But one surgeon (not of the same practice, so that's the difference) is not doing any pre- or post-op work. That's all done by the other surgeon. With that being clarified, is the -62 still correct?
    I do see that the -80 assumes surgical session only, I agree.
    Pam Brooks, MHA, COC, PCS, CPC, AAPC Fellow
    Coding Manager
    Wentworth-Douglass Hospital
    Dover, NH 03820

    If you can dream it, you can do it. Walt Disney

  5. Default
    I would still just bill the 62. I work in neurosurgery and we do have other specialties of a different practice assist. I would not bill the 54.

  6. Default
    Just to further clarify, they are increasing the allowable to 125% for modifier 62. Each physician would get half of that so the insurance company is already building in the reduction for the main surgeon and recognize that they didnt do the surgical care alone, but they recognize he provided the preop and post op care, so the main surgeon is already getting the reduction. On the other hand, the assisting surgeon is not getting 100% of the allowable for the code he is assisting on so he is already being "penalized" for not providing the preop and post op care. You would not bill a 54, this is building in a reduction when the reduction has already been taken into account for both surgeons.

  7. #7
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    Quote Originally Posted by Pam Brooks View Post
    That's my point, I think. As co-surgeons, (which the op notes clearly convey,) they do split 125% of the global fee. But one surgeon (not of the same practice, so that's the difference) is not doing any pre- or post-op work. That's all done by the other surgeon. With that being clarified, is the -62 still correct?
    I do see that the -80 assumes surgical session only, I agree.
    The 54 modifier is not allowed in conjunction with a 62 modifier. If both surgeons are doing the exact same procedure, just different parts of the procedure, I guess one of them just takes the responsibility for pre and post op work. They agree to split the fee equally regardless of the work involved. There is no other way to report this scenario at this time.
    Arlene J. Smith, CPC, CPMA, CEMC, COBGC

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