Two surgeons operating on the same patient, same session

March 18th, 2009 - Codapedia Editor
Categories:   Coding   Modifiers   Medicare Physician Fee Schedule (MPFSDB)   Surgical Billing & Coding  
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Most surgeries with two surgeons are reported and performed as the primary surgeon (no modifier on the CPT® code) and the assistant surgeon (modifiers 80, 81, 82, and AS).  Some surgeries, however, require two surgeons (modifier 62)  or a surgical team (modifier 66).  How does a physician or coder know if the surgery is eligible to be paid in this way?  Although commercial payment policies may vary, Medicare has a policy.  See the CPT® book for the complete descriptions of these modifiers.

The Medicare Physician Fee Schedule Data Base has two indicators for these topics.  Each surgical CPT® code has an indicator for whether or not two surgeons are allowed or whethe or not team surgeons are allowed for highly complex patients.  Before submitting claims in this way, check the Medicare Fee Schedule indicators to see if two or team surgeons are: allowed, never allowed, allowed with supporting medical documentation.  ( A link to the CMS site with a look up function for indicators is in the citations section of this article.)

For two surgeons, both surgeons submit the claim with the same CPT® code and append modifier 62 to their claim.  Each is paid 62.5% of the Medicare fee schedule amount. 

Here is the section from the Medicare Claims Processing Manual with the instructions: (Pub 100-04, Chapter 12, Section 40.8.B)

A.  General
Under some circumstances, the individual skills of two or more surgeons are required to
perform surgery on the same patient during the same operative session.  This may be
required because of the complex nature of the procedure(s) and/or the patient’s condition. 
In these cases, the additional physicians are not acting as assistants-at-surgery.
B.  Billing Instructions
The following billing procedures apply when billing for a surgical procedure or
procedures that required the use of two surgeons or a team of surgeons:
• If two surgeons (each in a different specialty) are required to perform a specific
procedure, each surgeon bills for the procedure with a modifier “-62.”  Co-surgery
also refers to surgical procedures involving two surgeons performing the parts of
the procedure simultaneously, i.e., heart transplant or bilateral knee replacements. 
Documentation of the medical necessity for two surgeons is required for certain
services identified in the MFSDB.  (See §40.8.C.5.);
• If a team of surgeons (more than 2 surgeons of different specialties) is required to
perform a specific procedure, each surgeon bills for the procedure with a modifier
“-66.”  Field 25 of the MFSDB identifies certain services submitted with a “-66”
modifier which must be sufficiently documented to establish that a team was
medically necessary.  All claims for team surgeons must contain sufficient
information to allow pricing “by report.” 
• If surgeons of different specialties are each performing a different procedure (with
specific CPT® codes), neither co-surgery nor multiple surgery rules apply (even if
the procedures are performed through the same incision).  If one of the surgeons
performs multiple procedures, the multiple procedure rules apply to that surgeon’s
services.  (See §40.6 for multiple surgery payment rules.)
For co-surgeons (modifier 62), the fee schedule amount applicable to the payment for
each co-surgeon is 62.5 percent of the global surgery fee schedule amount.  Team
surgery (modifier 66) is paid for on a “By Report” basis.
 

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