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co-surgeons during endoscopy

Amy Posted Wed 26th of March, 2014 11:37:17 AM

Our pediatric gastroenterologist scheduled a patient for an EGD, coordinating with one of our adult GI's doc's to do an EUS during the same session.
The peds GI does an EGD with bx (43239). Our other GI doc does the EUS to look specifically at the ampulla and biliary system, when the peds doc is finished (43259).
So two Dr's; same session; different procedures. When I look at modifier -62, sounds like the same CPT codes are reported. I researched CMS and they say no modifier is needed if the CPT codes are different. (Which sounds odd to me, b/c it's the same session - why would everyone get paid full amounts?)
My concern is that 43239 is bundled into 43259. My claims will have the same group tax ID, but different NPI's.
So, should I submit the 43239 with modifier -59? Seems to me if I do that, it says they were totally separate procedures, which they really weren't. What am I missing here?

SuperCoder Answered Thu 27th of March, 2014 10:03:16 AM

Instead of two codes bill it with 43242-62

or a co-surgery claim to work, however, the two physicians must coordinate their billing strategies. This requires three steps:

1. Because co-surgeons each perform a distinct part of the procedure, they can't share the same documentation. Each physician should provide a note detailing which portion of the procedure he performed, how much work was involved, and how long the procedure took.

2. Each physician should identify the other as a co-surgeon.

3. The co-surgeons should link the same diagnosis to the common procedure code.

Amy Posted Thu 27th of March, 2014 10:44:46 AM

43242 Describes an EUS with FNA (fine needle aspiration). That would be used for an ultrasound guided needle aspiration or biopsy. The biopsy done here was not ultrasound guided. Each Dr used a separate scope. The peds Dr used an EGD scope and took plain biopsies from the stomach lining. Our other Dr used an echoendoscope and did an ultrasound of the biliary system.

SuperCoder Answered Wed 02nd of April, 2014 08:56:22 AM

I believe the correct reporting in this scenario would be 43259 and then 43239-59. As you surmises, modifier 62 (Two Surgeons) is not applicable because different procedures are involved and the GI docs are working sequentially rather than concurrently. CCI bundles 43239 into 43259 unless a modifier is appended, so modifier 59 will need to be appended to 43239 if they want both codes paid, given the common tax ID number (i.e. both physicians billing under the same group number). Nothing in CPT precludes reporting both codes together (at least there is no parenthetical to that effect.) I had initially thought that modifier 51 (Multiple procedures) might also need to be appended to 43239, but that is not the case, since both of these codes are modifier 51 exempt, per CPT.

SuperCoder Answered Wed 02nd of April, 2014 08:56:22 AM

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