• Savvy Coder

    Modifier –62: How to Determine Whether You Can Bill for Cosurgery

    By Sue Vicchrilli, COT, OCS, OCSR, Academy Director of Coding and Reimbursement

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    The Office of Inspector General (OIG) recently announced that it would investigate how prac­tices are using modifier –62, which represents cosurgery. Make sure your practice is using it appropriately.

    Cosurgery 101

    The OIG, in its March 2020 work item, outlined the key features of cosurgery.

    What is cosurgery? Cosurgery oc­curs when “the individual skills of two surgeons are necessary to perform a specific surgical procedure or distinct parts of a surgical procedure (or procedures) simultaneously on the same patient during the same operative session.” However, billing for cosurgery isn’t an option for all CPT codes.

    Use modifier –62. Each surgeon “should report the specific procedure(s) by billing the same procedure code(s)” with modifier –62.

    Reimbursement. “By appending modifier –62 to the procedure code(s), the fee schedule amount applicable to the payment for each cosurgeon is 62.5% of the global surgery fee sched­ule amount.” So in total, CMS would pay 125% of the usual fee.

    Scope of audit. The OIG plans “to audit a sample of claim line items—specifically where different physicians billed for the same cosurgery procedure code, for the same beneficiary, on the same date of service.”

    When Not to Bill for Cosurgery

    When modifier –62 is used, it is often used in error. Here is a clinical example that might erroneously be considered cosurgery. It would involve a loss of reimbursement if billed as such.

    Example: Two specialists are involved in the same surgical session. A patient required cataract surgery in his right eye. It was known preoperatively that he would require a vitrectomy for a macular pucker. The cataract was too dense to allow an adequate view of the macula, so the retina and anterior segment surgeons performed the case together.

    The anterior segment surgeon submits 66984–RT. The operative note only addresses the cataract surgery and only reports the ICD-10 code specific to the type of cataract.

    The retina surgeon submits 67041–RT. The operative note only addresses the vitrectomy for the macular pucker, and only the macular pucker ICD-10 code is reported. (Note: Having a unique taxonomy number for retina may be beneficial; for more information, see aao.org/taxonomy.)

    Why does this not qualify for cosurgery? Even though CPT codes 66984 and 67041 are on the cosurgery approved lists, the two surgeons weren’t involved in performing the same procedure. They each performed a separate procedure.

    Tips. Watch the remittance advice (RA) to assure correct payment, which is 100% of the allowable for each surgeon. This is not an assistant-at-surgery situation.

    You Can Append –62 to Some CPT Codes, But Not Others

    How do you know that cosurgery is even an option for a specific CPT code?

    First, go to the Physician Fee Schedule Search, which is at www.cms.gov/apps/physician-fee-schedule.

    Set the search parameters. In the “HCPCS Code” field, enter the CPT code of the procedure, select “2020,” “Payment Policy Indicators,” and “All Modifiers,” and click “Submit.”

    Check the cosurgery column. A successful search will populate a chart for the CPT code that you submitted. See which of these three numerals is in the chart’s “Cosurg” column:

    • 0—cosurgeons not permitted for the procedure
    • 1—cosurgeons could be paid (sup­porting documentation is required to establish the medical necessity of two surgeons for the procedure)
    • 9—cosurgery concept doesn’t apply to the procedure

    Coding Tips

    Cosurgeons can be of the same spe­cialty. Years ago, the CPT had noted that cosurgeons are “usually of different specialties,” but that was deleted in 1999.

    Not for surgical assistants. If you are billing for an assistant-at-surgery, use modifier –80 or –82, not –62.

    Learn More About Modifiers

    For more on modifiers, including detailed instructions on how to apply them, buy 2020 Learn to Code: Complete Guide to the Essentials at aao.org/store.

    Cosurgery for the Eye

    The “Eye and Ocular Adnexa” section of the Current Procedural Terminology (CPT) includes scores of codes. Currently, if you were to use the CMS Physi­cian Fee Schedule Search for those codes, you would find that 102 of them have a cosurgery indicator of 1. This means that two cosurgeons can each use modifier –62 to bill for the same procedure. These codes are as follows: 65091, 65093, 65103, 65105, 65110, 65112, 65114, 65125, 65130, 65175, 65265, 65273, 65290, 65710, 65730, 65750, 65755, 65756, 65780, 65781, 65782, 65850, 65865, 65870, 65875, 65920, 65930, 66150, 66160, 66170, 66172, 66174, 66175, 66180, 66220, 66225, 66500, 66680, 66852, 66920, 66940, 66985, 66986, 66999, 67005, 67010, 67015, 67025, 67027, 67030, 67036, 67039, 67040, 67041, 67042, 67043, 67107, 67108, 67112, 67113, 67120, 67121, 67250, 67255, 67299, 67312, 67318, 67331, 67332, 67334, 67335, 67343, 67399, 67400, 67412, 67414, 67420, 67440, 67445, 67450, 67550, 67570, 67599, 67902, 67903, 67904, 67950, 67971, 67973, 67974, 67999, 68320, 68325, 68335, 68362, 68399, 68525, 68540, 68720, 68745, 68750, and 68899.

    No cosurgery. At time of press, the following codes from CPT’s “Eye and Ocular Adnexa” section have an indicator of 0, which means that cosurgeons are not permitted: 65101, 65135, 65140, 65150, 65155, 65205, 65210, 65220, 65222, 65235, 65260, 65270, 65272, 65275, 65280, 65285, 65286, 65400, 65410, 65420, 65426, 65430, 65435, 65436, 65450, 65600, 65710, 65757, 65770, 65772, 65775, 65778, 65779, 65800, 65805, 65810, 67975, 68020, 68040, 68100, 68110, 68115, 68130, 68135, 68200, 68326, 68328, 68330, 68340, 68360, 68371, 68400, 68420, 68440, 68500, 68505, 68510, 68520, 68530, 68550, 68700, 68705, 68760, 68761, 68770, 68801, 68810, 68811, 68815, 68816, 68840, and 68850.

    Cosurgery doesn’t apply. At time of press, the following codes from CPT’s “Eye and Ocular Adnexa” section have an indicator of 9, which means that the concept of cosurgery doesn’t apply to the procedure: 65760, 65765, 65767, and 65771. (These are the codes for keratomileusis, keratophakia, epikeratoplasy, and radial keratotomy, respectively.)