Victoria Posted Wed 26th of February, 2020 12:32:29 PM
Co Surgeon Billing
How would I code the following surgery with co surgeons? Surgeon A did the right breast. Surgeon B did the left breast. As you can see, they did not perform the exact procedures on each side.
Surgeon A Surgeon B
35236-RT 13101-59 LT
13101 RT 13102-59 LT
SuperCoder Answered Thu 27th of February, 2020 04:56:53 AM
When two surgeons work together as primary surgeons performing distinct part(s) of a procedure, each surgeon should bill 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.
When billing the surgical procedure with modifier 62, documentation of the medical necessity for two surgeons is required for certain services identified in the MPFS Indicator list for Q1, 2020.
- Indicator of 1- supporting documentation is required to establish medical necessity of two surgeons for the procedure
- Indicator of 2 - the payment rule for two surgeons apply
1.Indicator in MPFS (Medicare Physician Fee Schedule) for Q1, 2020 must be either 1 or 2
2.Both surgeons must agree to append modifier 62 on their claim.
3.Reimbursement is made at 62.5% of MPFS (Medicare Physician Fee Schedule)
4.Procedure code and diagnosis code should be same
Amongst the provided set of CPT codes, except CPT code 35236, none of the code qualifies under Indicator 1 and 2 and hence 62 modifier cannot be appended with the provided set of codes except CPT code 35236.
Please find below link for more understanding on coding guidelines for co-surgeons.
Hope provided information would be helpful.