There are two or more surgeons’ skills are required to perform surgery on the same patient within the same operative period in some cases. This may be necessary because of the complexity of the procedure(s) and the patient’s condition. In these circumstances, the other physicians are not serving as surgical assistants. If the surgery is invoiced with a modifier 62 and the indicator is 1, the claim will be suspended for human examination of any supporting documentation. When a procedure is billed with modifier 62 and the indicator is 2, the reimbursement rule for two surgeons applies.
If a particular procedure requires the services of two surgeons, each surgeon bills for the process using CPT modifier 62. (Two Surgeons). Co-surgery also relates to surgical procedures in which two surgeons conduct different parts of the process simultaneously, such as a heart transplant or bilateral knee replacements.
- A specific surgery for the patient must be performed by two surgeons (each from different expertise).
- Two surgeons (of the same or different specialty) conduct parts of the same operation simultaneously, such as heart transplants or bilateral knee replacements.
- Both physicians bill the same particular process with modifier 62 appended.
- 62.5 percent of the Medicare Physician Fee Schedule database is reimbursed (MPFSDB)
- In MPFSDB, the indicator must be either 1 or 2.
- One surgeon is serving as a surgical assistant.
- Rare cases, frequently in trauma conditions, where both surgeons are functioning concurrently but not on the same surgery
- There are more than two main surgeons in practice.
Modifier 62 Documentation
- To promote co-surgery, medical record paperwork should indicate each practitioner’s services.
- Identifying each surgeon’s many specialties and services
- The Medicare Physician Fee Schedule (MPFS) Relative Value File reporting indicator 1 (RSF), and the second claim will be put on hold while it is being reviewed.
- If the PFS RVF contains a co-surgery signal of “2” and both surgeons have separate specializations, Medicare may pay without further evidence.
Modifier 62 Example
Two surgeries are performed an upper gastrointestinal endoscopy with guided insertion of a percutaneous gastrostomy tube. A single surgeon performs the endoscopy. The gastrostomy tube is inserted through an incision in the abdomen made by the other surgeon. The surgery is suitable for co-surgery.
When billing, both surgeons should use the same CPT procedure code (43246) and modifier code 62. Both surgeons should send a copy of the operating report that details the part of the procedure that each completed. The plan coverage will be paid at 125 percent of the qualifying amount. The surgeons in this example have agreed on a mutually acceptable percentage share of the charge (70/30), which they have specified on the claims.
Codes eligible for the Co-Surgeon Modifier 62
For claims filed on or after July 1, 2018 (regardless of service date):
- Procedure codes on the Medicare Physician Fee Schedule (MPFSDB) with a co-surgeon indication of “0” are not suitable for co-surgery and will be denied if filed with it added.
- On the MPFSDB, procedure codes with a co-surgeon indicator of “1” need the provision of supporting material for review to verify the medical reason of two surgeons for the surgery.
- If the two surgeons are of different specializations, procedure codes with a co-surgeon indicator of “2” on the MPFSDB are suitable (co-surgery).
- In some cases, such as heart transplants or bilateral knee replacements, two doctors of the same specialization may be appropriate.
- Heart transthoracic aortic valve replacement (TAVR) with implantation 33361-33369 (TAVI).
- According to CPT rules for procedure codes 33361-33369, TAVR/TAVI operations require two physicians, and all parts must be reported.
- Procedure codes 33361-33369 will be rejected if they are not added.
- Procedure codes on the MPFSDB with a co-surgeon indication of “9” are not suitable; the co-surgeon notion does not apply. If these process codes are presented alongside them, they will be rejected.
Modifier 62 Billing and Coding Requirements
Both co-surgeons are required to charge the identical combination of procedure codes with modifier 62 applied for co-surgery treatments. Further procedures carried out during the same operating session may be listed as primary or assistant surgeon.
If a claim is submitted with a modifier attached after another claim for the same procedure has been reviewed and approved as the primary surgeon, the later claim with the modification attached is refused.
Suppose one surgeon files as the primary surgeon and another as a surgeon for the same procedures and information, and neither claim has been issued. In that case, both shares are halted, and a non-clean-claim review is initiated.
We hope that this article has provided you with all of the knowledge you need to use modifier 62 correctly. If you are still unsure and require assistance with medical billing for your clinic, please contact us. Billing executive medical billing Services has a skilled billing and coding staff that employs precise modifiers to ensure correct insurance reimbursement. To learn more about our medical billing services, please contact us at firstname.lastname@example.org
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