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. 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 (Two Surgeons). Co-surgery also refers to surgical procedures involving two surgeons performing the parts of the procedure simultaneously, i.e., a heart transplant.
- Co-Surgeons are defined as two or more surgeons, where the skills of both surgeons are necessary to perform distinct parts of a specific operative procedure. Co-surgery is always performed during the same operative session.
- An assistant surgeon is defined as a physician who actively assists the operating surgeon. An assistant may be necessary because of the complex nature of the procedure(s) or the patient’s condition. The assistant surgeon is usually trained in the same specialty.
- An assistant-at-surgery may be a physician assistant, nurse practitioner, or nurse-midwife acting under the direct supervision of a physician, where the physician acts as the surgeon and the assistant-at-surgery as an assistant.
The modifiers will be required when billing for a surgical procedure or procedures that required the use of two surgeons or a team of surgeons:
- Modifier 62 (Two Surgeons): When 2 surgeons work together as primary surgeons performing distinct part(s) of a procedure, each surgeon should report his/her distinct operative work by adding modifier 62 to the procedure code and any associated add-on code(s) for that procedure as long as both surgeons continue to work together as primary surgeons. Each surgeon should report the co-surgery once using the same procedure code. If additional procedure(s) (including add-on procedure(s) are performed during the same surgical session, separate code(s) may also be reported with modifier 62 added.
- Modifier 66 (Surgical Team): Under some circumstances, highly complex procedures (requiring the concomitant services of several physicians or other qualified health care professionals, often of different specialties, plus other highly skilled, specially trained personnel, various types of complex equipment) are carried out under the “surgical team” concept. Such circumstances may be identified by each participating individual with the addition of modifier 66 to the basic procedure number used for reporting services.
- Different procedures require no modifier: If surgeons of different specialties are each performing a different procedure (with different CPT codes), neither co-surgery nor multiple surgeon 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.
- A provider bills for CPT Code 61548, Hypophysectomy or excision of pituitary tumor, and bills with modifier 62, for a patient on the date of service March 8, 2012. Different provider bills for the same service for the same patient on the same date of service because he/she was the co-surgeon, yet did not bill with the modifier 62. The second surgeon was overpaid for failing to properly apply modifier 62.
- A provider bills for CPT Code 49652, Laparoscopy, Surgical repair, ventral, umbilical, Spigelian or epigastric hernia, and bills with modifier 62, for a patient on July 2, 2011. Different provider bills for the same service for the same patient on the same date of service because he/she was the co-surgeon, yet did not bill with modifier 62. The second surgeon was overpaid for failing to properly apply modifier 62.
- An orthopedic surgeon prepares a patient for an anterior lumbar interbody fusion at L3-L4 and L4-L5. He plans to place cages at both intervertebral spaces. A general surgeon dictates the approach, listing himself as a surgeon and the orthopaedist as co-surgeon. In his operative note, the orthopaedist lists himself as the surgeon and lists the general surgeon as the co-surgeon. The orthopaedist dictates the definitive procedure after the approach. The orthopedic surgeon’s claim submission would look like: 22558-62 (anterior fusion) and 22585-62 (additional spinal fusion) for an orthopedic surgeon and general surgeon.
It is critical to appropriately document the role of each physician, as well as the medical necessity of the second surgeon/assistant. When two surgeons are reporting services as co-surgeons, two distinct operative notes are required. The operative notes should not overlap because this negates the concept of co-surgery and will drive the use of the appropriate assistant versus co-surgeon modifiers.
Do not append an assistant surgeon or assistant at surgery modifier if the physician does not document the role associated with the procedure. For example, an assistant is usually not required for the bone grafting procedures because only one surgeon inlays the allograft or autograft. Finally, watch your reimbursements closely and appeal inappropriately denied services!
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