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 in the practice must confirm that both claims have the same ICD-9 code(s).
Tip 4: Each physician must submit his own claim with his own documentation. Because claims for co-surgeons of the same specialty can come under scrutiny, each physician must diligently detail both the work he or she performed and the work the other physician performed.
Many physicians submit a letter to the carrier detailing the reason for two surgeons. Because modifier 62 requires so much claims coordination, get game plans together outlining what each surgeon is going to do to complete the procedure and how they are both going to document and code for it. This is one surefire way to improve your chances of getting the reimbursement you deserve on the first try.
