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Following two scenarios tell you when you should and shouldn't append modifier 62. Medicare has shifted the co-surgeon indicator for 57155 to a "2." This implies that co-surgeon reporting is allowed -- however do you know how to correctly report co-surgery claims? In case you're not certain when modifier 62 is applicable and what documentation your physician should deliver, you could face a denial that's complicated to appeal. Read this expert ob-gyn coding insight and ward off denials. Solution: Take a look at following two scenarios -- one is where the physicians help each other and the other one is where the physicians carry out distinct parts of the procedure -- and learn when you should apply modifier 62. Scenario 1: Both MDs Perform Same Procedure Assume a urologist and an ob-gyn carry out a bladder suspension as well as a hysterectomy at the similar surgical session. Solution: Both physicians must report 58267 (Vaginal hysterectomy, for uterus 250 grams or less; including colpo-urethrocystopexy [Marshal-Marchetti-Krantz type, Pereyra type] including or excluding endoscopic control) or 58293 (Vaginal hysterectomy, for uterus more than 250 grams; with colpo-urethrocystopexy [Marshall-Marchetti-Krantz type, Pereyra type] including or excluding endoscopic control). You must report the above claim as two surgeons (modifier 62). In other words, both surgeons are going to code the chief procedure with modifier 62. Reason: In case one specialist executes one part, or component, of a procedure, and other specialist is carrying out a different part of the procedure, payers will take them as co-surgeons. This implies that the physicians should respectively report the same CPT® code using modifier 62. Using modifier 62, each surgeon will get 62.5 percent of the assigned fee for the service, lest the surgeons consent to a different split beforehand, which they would communicate to the payer. Scenario 2: Each MD Performs Distinct Services But what if the services executed by both the specialists aren't covered by a single code? In case both the surgeons are working on the execution of two distinct procedures in the same surgical session, you are not supposed to use modifier 62 and define the surgery a co-surgery as the physicians won't be reporting the same code. In this case, each physician should report the code for the service he provided, without a modifier. Example: A patient goes through a vaginal hysterectomy as well as a sling procedure. In this case, both surgeons must report a distinct code(s) to represent their individual service(s). The urologist should report 57288 (Sling operation for stress incontinence [for instance, fascia or synthetic]), and the gynecologist should report either 58260 (Vaginal hysterectomy, for uterus 250 grams or less) or he should report 58262 (... with removal of tube[s], and/or ovary[s]). Modifier 62 is no longer applicable as the surgeons report two distinct codes. Want to have more expert ob-gyn coding and billing and know everything about ob-gyn CPT codes? Click here to read the entire article and to get access to our monthly Ob-Gyn Coding Alert: Your practical adviser for ethically optimizing ob-gyn coding and billing, payment and gaining expertise on ob-gyn CPT codes Read more to perfect your ob-gyn coding and billing: http://www.supercoder.com/articles/articles-alerts/oca/news-you-can-use-57155-make-the-co-surgery-indicator-shift-from-1-to-2-106059/
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