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Margaret Posted Thu 08th of September, 2016 13:09:37 PM
A severe MVA resulted in patient undergoing surgery for multiple fractures. Both orthopedists from our practice worked together at same surgical session, one repairing fractures on upper extremities and other repairing fractures on lower extremities. Our PA assisted on all procedures. One surgeon is saying this is considered cosurgery by the two orthopedists and the other one is saying it is 1st and 2nd assistants with the other orthopedist and the PA. Should each surgeon be billed as cosurgeon or first assistant on each procedure? THank you for your help.
SuperCoder Answered Fri 09th of September, 2016 08:11:56 AM
  • Cosurgery means that two surgeons are performing distinct separate parts of the same procedure. This most frequently occurs when one surgeon performs the approach and the other surgeon performs the definitive procedure. For both surgeons to receive appropriate reimbursement, they must not be assisting each other, but performing distinct and separate parts of the same procedure.
  • When there is an assistant surgeon or an assistant at surgery, the surgeon of record is listed as the primary surgeon. The surgeon of record is responsible for identifying the presence of the assistant surgeon or assistant at surgery and the work performed. In this situation, the assistant surgeon or assistant at surgery does not dictate an operative note. An MD or DO serving as the assistant surgeon will report the CPT codes for those procedures.
  • Surgeons of the same or different specialty can use modifier -62, but unlike assistant surgeons, each co-surgeon must dictate a separate operative report documenting his/her distinct operative work. The operative report should indicate the medical necessity for having two surgeons act as co-surgeons.
  • The role of each one must be clearly identified and the procedures reported by each must be well documented.

So, if in your scenario each surgeon is dictating seperate operstive report you can bill for co-surgeon. But if each surgeon is not dictating its operative report and is listed as asistant surgeon by primary surgeon you need to bill as assistant surgeon.


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