Vicki Posted Thu 04th of January, 2018 17:26:13 PM
Our orthopedic surgeons commonly perform anterior lumbar interbody fusions (ALIFs) and will bring in general surgeons to perform the approaches. What is the correct code to append the 62 modifier to? It is our understanding that the 62 should be billed on the fusion code (22558) as the approach surgeon does not participate in any part of the surgery other than the approach. However, we've learned that some of our approach surgeons are billing a miscellaneous code (22899) in addition to the fusion code with the 62 mod. This seems like double-dipping to us. Clarification would be much appreciated.
SuperCoder Answered Fri 05th of January, 2018 05:12:50 AM
The clinical responsibility for the CPT code 22558 is, patient is appropriately prepped and anesthetized, the provider makes an incision on the left side of the abdomen. He retracts the abdominal muscles to one side. He retracts the intact peritoneum to reach the lumbar spine. He identifies the target vertebrae. He removes the annulus and uses a curette to remove some of the disk material to create space inside. He drills the bony end plate and inserts bone graft into the empty disk space. The provider then irrigates the area, checks for bleeding, removes any instruments, and closes the incision.
The approch also included in the procedure, so need not to bill separeately.
Modifier 62 is used When two providers work as primary surgeons, and each performs part of a procedure (as done in your case). Each surgeon reports the same procedure code to the payer. Medicare reimburses each provider a percentage of the Medicare global surgery fee schedule amount for the procedure. Each provider must clearly document the components of the surgery he performed.
Examples of two providers working as primary surgeons for a procedure include:
–Complex conditions, such as a trauma patient in surgery for an extended period of time, which causes the surgeons to work in shifts to complete the procedure.
–Situations where each provider performs a component of the same procedure, such as a general surgeon preparing the surgical site, and a different surgeon performing the surgery.
So, append modifier 62 with your primary procedure code i.e. 22558.