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Modifier confusion

  1. #1
    Location
    Fort Wayne, IN
    Posts
    25
    Default Modifier confusion
    Medical Coding Books
    If an op report states "assistance from another MD" would require a 62 or 80 modifier. I am confused about the difference between the two. Any help would be greatly appreciated.

  2. #2
    Default
    Hi,

    If the Op Report says "Assistant Sugeon", then I would use an 80 modifier. If the report states "Co-Surgeon", then it's 62. Since modifier 80 is a more commonly used modifier, I've included a brief overview on the 62:

    Modifier 62
    Definition: Two Surgeons

    Co-Surgery is the cooperation of two surgeons doing a surgery within the same body cavity with a single primary goal, with each of the two surgeons applying their individual skills to achieve that single goal, while assisting each other. Co-surgery may also apply to procedures that require two or more surgeons, neither acting as an assistant to perform the total procedure(s). It may also apply when a surgical procedure involves two or more surgeons performing parts of a single procedure or related procedures simultaneously, e.g., heart transplant, bilateral orthopedic or vascular procedures.

    Each surgeon must bill using the same CPT codes, with modifier 62. Co-surgery codes approved by CMS for Co-surgery are reimbursed to the maximum allowance for the surgeon and an assistant combined to one fee and then divided between the co-surgeons. Procedure codes must have either a Medicare Co-surgery indicator of ‘1' or ‘2' to be considered for payment. Pricing is 120% of allowable which is split 50/50 between two surgeons equaling 60% of allowable for each surgeon. If there is more than one procedure performed, multiple surgery guidelines apply.

    Hope that helps!
    Sylvia Thompson, CPC
    Billing Supervisor
    San Diego, CA

  3. #3
    Location
    Milwaukee WI
    Posts
    4,466
    Default Assist vs Co-surgeon
    Also, if the surgeon is an ASSISTANT, then only ONE operative report needs to be dictated, by the primary surgeon (the assistant surgeon does not need to dictate a report at all).

    If the two surgeons are co-surgeons, EACH much dictate his/her own operative report detailing what s/he did.

    In both cases, both surgeons use the identical CPT code.
    Co-surgeons both use the -62 modifier
    For assistant surgeon, only the assistant surgeon uses the -80 modifier (or -82 if you are in a teaching hospital; AND if in a teaching hospital there must a statement by the primary surgeon that no qualified resident was available to assist in order to bill for the assistant surgeon.)

    F Tessa Bartels, CPC, CPC-E/M

  4. Default
    Quote Originally Posted by Jennifer1013 View Post
    If an op report states "assistance from another MD" would require a 62 or 80 modifier. I am confused about the difference between the two. Any help would be greatly appreciated.
    Hello,
    An MD can't bill as a surgeon- MD means a masters degree in medicine and not surgery, I understand- So, both the options are ruled out.
    May be the MD can report for his/her standby services, if explainable.

  5. #5
    Location
    Milwaukee WI
    Posts
    4,466
    Default MD = Doctor of Medicine
    Lavanya ...
    In the United States "MD" signifies a "doctor of medicine" ... could be any physician, including psychiatrist or surgeon.

    F Tessa Bartels, CPC, CPC-E/M

  6. Default HELP! I also need assistance with billing Assistant Orthopedic Surgery
    If I bill for the procedure under the MD's name how does the PA get paid? Is there additional reimbursement for the MD so he can pay his assistant? If so how to I notify the insurance that there was an assistant in the OR?


    If I bill the MD's charges on one line and bill the PA's on another line with a modifier 80 but in the PA's name will the PA be paid if she isn't contracted with the insurance?



    Thanks
    you can contact me directly at 602.443.2188!

  7. #7
    Default You won't get paid for the PA from most commercial payers
    You won't get paid for the PA and the MD from most commercial payers. Most that I know of will only allow one assistant.
    *************
    PB

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