62 - JF Part B
Two Surgeons. The individual skills of two or more surgeons 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 (each in a different specialty) are required to perform a specific procedure, each surgeon bills for the procedure with a modifier 62.
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.
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
- 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
Dr Smith and Dr Jones (both orthopedic surgeons) performed as co-surgeons an Arthrotomy of the elbow, with capsular excision for capsular release (separate procedure). Co-surgery Indicator 2.
Allowance based on 62.5% of the allowable for code 24006 for both surgeons. No documentation needed. So if the allowance is $752.04, then 62.5% of this amount is $470.03 for each surgeon.
Last Updated Thu, 16 Nov 2017 13:52:40 +0000