Follow 4 Simple Tips for Modifier 62 to Get your Game Plan in place for both Codes and Documentation

When two surgeons work together to perform one procedure, each physician’s individual documentation requirements can get jumbled up.  Make sure your physician isn’t passing the documentation buck and that he or she knows to follow these four tips when you submit claims with modifier 62.

Tip 1: Each physician should identify the other as a co-surgeon. Also make sure that the other physician is billing with modifier 62. A lot of confusion can arise when physicians from different practices are reporting the same procedure.

You may find yourself in a situation where one physician may report the other physician’s work as that of an assistant surgeon, in which case the claims would not correspond. This means a denial will hit your desk. One surgeon cannot simply indicate the other as the co-surgeon. Both physicians must submit claims for the same procedure, both with modifier 62. To accomplish this all you only need to call with a simple courtesy to the other physician’s billing or coding department.

Tip 2: Each physician should document her own operative notes. When surgeons are acting as “co-surgeons,” it is implied that they are each performing a distinct part of the procedure, which means they can’t “share” the same documentation. Each physician should provide a note detailing what portion of the procedure he or she performed, how much work was involved, and how long the procedure took. Including a brief explanation of the need for co-surgeons will help to avoid denials and reimbursement delays.

Tip 3: Each physician must link the same diagnosis code to the common procedure code. Though this requirement may seem obvious, if two physicians serve as co-surgeons to perform one procedure, the diagnosis code(s) they link to the CPT® code should be the same.  Before submitting a claim with modifier 62, someone...

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Follow 4 Simple Tips for Modifier 62 to Get your Game Plan in place for both Codes and Documentation

When two surgeons work together to perform one procedure, each physician’s individual documentation requirements can get jumbled up. Make sure your physician isn’t passing the documentation buck and that he or she knows to follow these four tips when you submit claims with modifier 62.

Tip 1: Each physician should identify the other as a co-surgeon.  Also make sure that the other physician is billing with modifier 62. A lot of confusion can arise when physicians from different practices are reporting the same procedure.

You may find yourself in a situation where one physician may report the other physician’s work as that of an assistant surgeon, in which case the claims would not correspond. This means a denial will hit your desk. One surgeon cannot simply indicate the other as the co-surgeon.  Both physicians must submit claims for the same procedure, both with modifier 62. To accomplish this all you only need to call with a simple courtesy to the other physician’s billing or coding department.

Tip 2: Each physician should document her own operative notes. When surgeons are acting as “co-surgeons,” it is implied that they are each performing a distinct part of the procedure, which means they can’t “share” the same documentation. Each physician should provide a note detailing what portion of the procedure he or she performed, how much work was involved, and how long the procedure took. Including a brief explanation of the need for co-surgeons will help to avoid denials and reimbursement delays.

Tip 3: Each physician must link the same diagnosis code to the common procedure code. Though this requirement may seem obvious, if two physicians serve as co-surgeons to perform one procedure, the diagnosis code(s) they link to the CPT® code should be the same.  Before submitting a claim with modifier 62, someone...

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AK Removals: Earn $120 by Following 17000-17111 with 99201

Stick to these 3 tips for your E/M and lesion removal procedures.

You can report both the E/M and lesion removal if the E/M service was a significant and separately identifiable service for an E/M service with actinic keratoses (AK) removal procedure.

Always verify with your carrier before appending modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to the E/M code.

You can only consider reporting modifier 25 when coding an E/M service, says Janet Palazzo, CPC, coder for a practice in Cherry Hill, N.J. If the procedures you are reporting don’t fall under E/M services, it is possible the encounter qualifies for another modifier instead.

Have a look at the following three tips to help you report these services accurately so your practice won’t miss out on about $41 for 99201 and $80 for 17000 or more, according to national averages indicated in Medicare’s 2011 Physician Fee Schedule.

1. Know When You Should Charge an E/M

Each insurer has its own guidelines for office visits (99201- 99215, Office or other outpatient visit …) and lesion removals (17000-17111, Destruction, Benign or Premalignant Lesions). So, knowing whether to appeal an E/M denial is difficult unless you know that the service deserves payment.

You should report the office visit (99201-99215) in addition to the procedure when the dermatologist performs a significant, separately identifiable E/M service from the AK removal, especially if the patient is new to your practice.

Along with the appropriate E/M code, report any diagnoses that come with that examination, which may include more than just the AK.

For example, if a patient comes in for an initial AK visit, you should charge an E/M service, since the physician has to examine the area and discuss...

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Per New CMS Transmittal Modifier, All Claims With Modifier GZ Will Be Denied Immediately

As per the latest CMS regulation, all claims with modifier GZ appended will be denied straight away. It is not unusual even in the best-run medical practices that the physician performs a noncovered service and doesn’t get an ABN signed. If you shoul...

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Does Modifier GY on 92015 Equal Payment?

Question: A doctor recently told me that appending modifier GY to the refraction code would guarantee payment by a secondary insurer when Medicare denies it. Is this true? Answer: Modifier GY (Item or service statutorily excluded or does not meet the ...

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Surgical Modifiers: Protect Yourself From Instant ‘PC’ Claim Denials

Don’t let ‘wrong surgery’ modifier mistakes stall your reimbursement.

You use modifier TC for the technical component of a test. So logically, you should use modifier PC for the professional component, right? Wrong. But many coders are making that mistake...

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Use This Sample Appeal Letter As Ammo in Your Fight Against Modifier 25 Denials

Attach your procedure notes and the OIG’s report to pack extra punch.

Even if you follow all of CMS’s rules in reporting modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the

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10060 Won’t Wash for Some I&Ds

Careful: A pilonidal cyst I&D is a separate animal. Question: A patient presents to the ED reporting pain in her spine. During the exam portion of a level-three E/M, the physician discovers that the painful area is red, and slightly warm to the touch. The patient also has a low-grade fever that she says she noticed about [...] Related articles:

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  3. Wound Closure Coding: Make the Simple, Intermediate DistinctionAccounting for depth is a tricky task when coding closure....

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Coders: Watch Out for Claim-Denying Computer Glitches

Don’t wait for your MAC to alert you to an error — be on the lookout for them. If you’ve been losing reimbursement to computer hiccups at your carrier, you’re not alone. Earlier this year, thousands of Medicare recipients in one state were wrongly told their benefits were being cut by $300 — but the state decided not to notify those affected with a letter. Instead, the state only told [...] Related articles:

  1. Medical Office Billing: 7 Ways to Escape Computer Claim CasualtiesPay attention to EOBs and keep talking to your MAC....
  2. Modifier 22 Moves for Ob-Gyn CodersThis U/S tactic will save you time — and add money...
  3. 15% More Pay Awaits Coders Who Can Max Out NPP BenefitCorrectly code NPP’s hospital services, or you’ll sell the practice...

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