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Two procedures two doctors mod 52?

  1. #1
    Location
    Johnson City, TN
    Posts
    11
    Default Two procedures two doctors mod 52?
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    If Dr Bill from another practice opens a patient and performs a surgery and before he closes my doctor steps in and using the same incision performs a seperate surgery on a differant body system. He then steps out and the first doctor closes.

    Since my doctor didn't open or close (which is included in the package) do I code the whole procedure or do I have to use a 52 modifier?

    Thanks
    Mike

  2. #2
    Location
    Louisville, KY
    Posts
    1,101
    Default
    Wow, good one.

    I think I'd code the CPT representative of the actual service and append a -52.

    Here's my next question: who's doing post-op followup for both surgeries? Each doc. sort of taking care of his/her own or what? If you have the ability to look ahead at that prospect, I think you could get away with reporting -54/55 etc in lieu of the -52. Probably not an option though.

    (I think Mod-66 is too far out there to be appropriate in this instance. Let me say that I have no experience using '-66, so perhaps that's why I'm overlooking it; just doesn't quite seem to fit. Of course, you've got the Op Report. )

    Well, good luck. Hope this helps some.

  3. #3
    Location
    Louisville, KY
    Posts
    24
    Default
    I think, from a payor perspective of course, that a modifier of -54 would be more appropriate in this instance.
    Modifier -54 states, "Surgical Care only: When one physician performs a surgical procedure and another provides preoperative and/or postoperative management.

    Didn't the first Provider do a totally different procedure and the 2nd Provider do another?

    The first Provider did both the pre-op and post-op care on the patient. The 2nd provider would need to add the -54 modifier.

  4. #4
    Location
    Louisville, KY
    Posts
    24
    Default
    In addition....the opening and closing of a patients surgical entry site is usually inclusive to the procedure performed. The modifier -54 is telling us what the second provider did more in detail.

    modifier -52 makes me think that there was only one surgery on the DOS, with no other Physician present.

    Any feedback would be greatly appreciated.

    Thanks

    Anthony Bush, CPC, CCP
    Medical Records Review Coordinator

  5. #5
    Location
    Louisville, KY
    Posts
    24
    Default
    Mike,

    If possible could you have more information on this? I've been thinking and need some more details.

    What was the procedure of the 1st surgeon? Will the 1st surgeon be doing the pre-op and post-op care for both procedures or just his?

    What was the procedure of the 2nd surgeon who just went in and done his procedure and back out...using the same incision? Will the 2nd surgeon be doing any post-op care?

    Please, if possible send as much information as possible. Thanks in advance...this looks to be a great discussion. Mr. Shields and I have been talking concerning this and would appreciate more information.

    Anthony Bush, CPC, CCP
    Medical Records Review Coordinator

  6. #6
    Default
    Modifier 66 would not be appropriate since this is really not team surgery. Nor is it co-surgery, modifier -62.

    There really is no reason why you can't code the claim with both 54 and 52, as most payers (Medicare included) accept multiple modifiers. Many will accept anywhere from 3-4 modifiers (although typically the first two are used in pricing and adjudication).

    If you use modifier -54 as the first modifier, you are letting the payer know you only performed the intraoperative portion of a procedure. Modifier 52 will let them know this is a reduced procedure in that you did not need to perform the opening or closing - the payer may or may not discount their fee upon review. You will need to send documentation to explain the reduced portion of the procedure.

    Who is actually following up on the patient?

    Louise

  7. #7
    Location
    Johnson City, TN
    Posts
    11
    Default
    Hi guys,

    OK.... the surgeries are normally like a hysto (gi) and our (gu) steps in and does a TVT for prolapse of pelvic floor, or stress incont. Our Doc may or may not do a follow up, but the other does post management.

    Or.. a gi cuts ureter and our gu setps in and repairs the ureter and steps out. Again.. may or maynot follow up depending on symptoms post opp.

    Thanks
    Mike

  8. #8
    Location
    Johnson City, TN
    Posts
    11
    Default
    I was thinking the 52 due to not opening or closing, the other Doc would bill a complete procedure as his was complete. The 54 with the 52 sounds right if no post opp managment.

    Mike

  9. #9
    Location
    Louisville, KY
    Posts
    24
    Default
    Mike thanks for the additional information. I think your Doc...the one going in after the patient was already opened should bill with a modifier of -52..
    Yesterday I was thinking of the other physician...I think...oh well that was yesterday...Just be sure and include in the documentation..the reason why your Doc is reducing his services.

    Anthony Bush, CPC, CCP
    Medical Records Review Coordinator

  10. Default
    Why wouldnt a modifier 80 or 81 be appropriate? Does your MD list the primary surgeon as assistant on his OP note? I would think that your doc would bill his portion as primary and the other MD would bill with an 80 or 81, depending on his/her level of involvement. The insurance company would reduce from there.

    In response to the 54 modifier, most of the urologists that I've worked with do post op care on a TVT or a nicked ureter and this modifier wouldnt be appropriate.

    Any other opinions out there???

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