62 - JE Part B

Two Surgeons. The individual skills of two surgeons (each in a different specialty) 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 and the additional physician is not acting as an assistant at surgery. If the two surgeons are required to perform a specific procedure, each surgeon bills for the procedure with a modifier 62.

Instructions

Co-surgery also refers to surgical procedures involving two surgeons performing the parts of the procedure simultaneously (e.g., heart transplant or bilateral knee replacements). Documentation of the medical necessity for two surgeons is required for certain services identified in the Medicare Physician Fee Schedule Database (MPFSDB).

If the surgery is billed with a modifier 62 and the indicator is 1, the claim will suspend for manual review of any documentation submitted with the claim. If the surgery is billed with a modifier 62 and the indicator is 2, then the payment rule for two surgeons apply.

If surgeons of different specialties are each performing a different procedure (with specific CPT codes), neither co-surgery nor multiple surgery 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.

Correct Use

• Both surgeons must agree to append modifier 62 on their claim
  • Reimbursement at 62.5% of MPFSDB
  • Indicator in MPFSDB must be either 1 or 2
• Procedure code and diagnosis code should be same
• Billed amount might not be same

Incorrect Use

• Modifier 62 must be on both claims or one physician will be paid at 100% and other physician's claim will deny
• Both surgeons must use same CPT code

Claim Coding Example

Surgeon A and Surgeon B (one general surgery, second orthopedic surgery) performed as co-surgeons on a spinal discectomy surgery. Surgeon A performed initial incision via cervical approach, excision of the disc, preparation for fusion, and closed the wound. Surgeon B removed a ligament and end plates, inserted and trimmed the bone graft. Co-surgery Indicator 2.

Surgeon A

Surgeon B

Allowance based on 62.5% of the allowable for code 22554 for both surgeons. No documentation needed. If the allowance is $1,350.62, then 62.5% of this amount is $844.14 for each surgeon.