Here's a scenario: A 70-year-old female patient who presents with COPD and coronary artery disease, status post myocardial infarction (CAD s/p MI) has a 28 mm of inner diameter thoracic aortic aneurysm. Imaging studies indicate the aneurysm to be descending. The cardiologist teams up with a thoracic surgeon and decides to perform an open operative repair with graft replacement of the diseased segment.
The key in a multi-provider scenario is to treat each physician's work as a separate activity. But then, deciding when to report a case as co-surgery, assistant surgery -- or something else -- has more to it than meets the eye. Here are some expert advice:
Modifier 62, 81, 82
In this situation, a modifier is at hand; but then, more importantly you should be able to tell what role each modifier plays so that your procedure codes blend well together. Take a look at these common modifiers used in multi-provider situations:
The key in a multi-provider scenario is to treat each physician's work as a separate activity. But then, deciding when to report a case as co-surgery, assistant surgery -- or something else -- has more to it than meets the eye. Here are some expert advice:
Modifier 62, 81, 82
In this situation, a modifier is at hand; but then, more importantly you should be able to tell what role each modifier plays so that your procedure codes blend well together. Take a look at these common modifiers used in multi-provider situations:
Modifier 62 (Two surgeons). Use this modifier to each surgeon's procedure when the physicians perform distinct, separate portions of the same procedure. Also called co-surgery, modifier 62 applies when the skill of two surgeons (normally of different skills) is called for in the management of a special surgical procedure.
Opt between modifier 80 (Assistant surgeon), modifier 81 (minimum assistant surgeon), and modifier 82 (Assistant surgeon [when qualified resident surgeon not available]) when one surgeon aids the other with multiple portions of the case rather than completing his work independently. What to look for? Ensure your physician indicates in his documentation that he is working with an assistant surgeon, what the assistant surgeon did, and why he or she was used during the case.
When you report a nonphysician practitioner's (NPP's) involvement to Medicare, attach modifier AS (Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery).
But remember that not all payers recognize modifier AS. You should verify the proper way to report the NPP's service before completing your claim.
Stay away from the modifier 51 trap
When you are coding for multiple procedures during the same operative session, it is easy to fall into the lure of using modifier 51 (Multiple procedures). However you could end up in the gutters if you are not careful enough.
Here's why: Modifier 51 tells you that a surgeon was present carrying out multiple procedures. If a surgeon is not present physically for multiple procedures in a surgical case, it is not proper to indicate that he was busy using modifier 51.
Two surgeons require two echo claims
In the given scenario, both surgeons should bill 33880. (Then, you'd use 441.2 (Thoracic aneurysm without mention of rupture) with 33880 to describe the condition. Finally, you should use modifier 62 to 33880 to show that two surgeons performed the repair.
Catch: You do not use modifier 62 if the physicians are not reporting the same CPT code(source"http://www.supercoder.com/cpt-codes"). If each doctor can represent his work with a separate CPT code, leave out modifier 62. Ensure both surgeons send a claim with the same code and modifier declared or you would end up throwing away about $4,000 in reimbursements (56.62 RVUs multiplied by 2011 conversion factor of 33.9764; $1,923.74 for each surgeon).
But remember that not all payers recognize modifier AS. You should verify the proper way to report the NPP's service before completing your claim.
Stay away from the modifier 51 trap
When you are coding for multiple procedures during the same operative session, it is easy to fall into the lure of using modifier 51 (Multiple procedures). However you could end up in the gutters if you are not careful enough.
Here's why: Modifier 51 tells you that a surgeon was present carrying out multiple procedures. If a surgeon is not present physically for multiple procedures in a surgical case, it is not proper to indicate that he was busy using modifier 51.
Two surgeons require two echo claims
In the given scenario, both surgeons should bill 33880. (Then, you'd use 441.2 (Thoracic aneurysm without mention of rupture) with 33880 to describe the condition. Finally, you should use modifier 62 to 33880 to show that two surgeons performed the repair.
Catch: You do not use modifier 62 if the physicians are not reporting the same CPT code(source"http://www.supercoder.com/cpt-codes"). If each doctor can represent his work with a separate CPT code, leave out modifier 62. Ensure both surgeons send a claim with the same code and modifier declared or you would end up throwing away about $4,000 in reimbursements (56.62 RVUs multiplied by 2011 conversion factor of 33.9764; $1,923.74 for each surgeon).
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