You Should Know When You Can Use Modifier 62

Remember that all CPT code is not eligible for reimbursement with a co-surgeon. Find out when you can use modifier 62 (Two surgeons) by looking to column AB in the Excel version of the 2011 Fee Schedule database, available for download at www.cms.gov/PhysicianFeeSched.

For modifier 62 claims, most payers shell out an additional fee (normally 125 percent of the ‘usual' fee for the procedure, divided equally between the two surgeons). Stay away from reimbursement problems by checking these claims cautiously.

A "2" in column AB next to the code you are investigating means that Medicare will pay for a co-surgeon for that procedure and that you do not require to submit documentation with the claim, so long as each surgeon is of a different specialty.

A "1" in column AB indicates that Medicare may pay for a co-surgeon; however you must submit documentation to explain the medical necessity for a co-surgeon. In comparison, a "0" means that Medicare will never pay two surgeons for the service whereas a "9" means that the concept of co-surgery doesn't apply for that particular code (and as such you should never apply modifier 62).

For instance: Medicare takes most wound repairs to be comparatively simple procedures and as such not eligible for payment with a co-surgeon. For example, the database assigns a "0" to column AB for codes 12001-12006, which means that you cannot be reimbursed with a co-surgeon with these procedures.

However for more extensive repairs such as those described by 12007, CMS assigns a "1" to column AB, meaning that Medicare may pay for a co-surgeon if documentation clearly explains why this is required.

To claim co-surgeons, each surgeon must carry out a distinct portion of a single CPT procedure and each surgeon must dictate and submit his own operative report for his portion of the surgery.

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