Modifier 62 - Do not miss to report

While doing medical coding for surgeons we should clearing know when to append modifier 62 and when not to. Let's see few tips below to avoid incorrect billing.

• Modifier 62 applicable if both surgeons participated are from different specialties.

• Do not append modifier 62 if both surgeons of different specialties are each performing a different procedure coded to different CPT codes.

• Modifier 62 need to be appended on the claim forms of both participated surgeons – billing co-ordination is required.

• If a co-surgeon assists another surgeon with a procedure, but is not another primary surgeon, append modifier 80, Assistant Surgeon.

• If more than 2 surgeons of different specialties involved to perform a specific procedure then use modifier 66 for each surgeon while sending claim.

• Failing to append Modifier 62 will result in over payment and lead to compliance issue.

Example: Two surgeon performed repair of incarcerated inguinal hernia on 22 yr. old patient and are belong to two different specialties.

• · Surgeon A billed 49507 with modifier 62 and surgeon B billed 49507 without modifier 62 then surgeon B will be over paid.

• · Both Surgeon A & B reported modifier 62 on claim form then both will receive 62.5% of the total allowed amount from the payer.

Let’s get to know official wordings for the application of modifier 62. The Medicare Claims Processing Manual, Chapter 12, Section 40.8, Claims for Co-surgeons and Team Surgeons, provides the following guidance:

“Under some circumstances, individual skills of two or more surgeons are required to perform surgery on the same patient during the same operative session. This may be required because of the complex nature of the procedures and/or the patient’s condition. In these cases, the additional physicians are not acting as assistants-at-surgery. If two surgeons (each in a different specialty) are required to perform a specific procedure, each surgeon bills for the procedure with a modifier 62. Co-surgery also refers to surgical procedures involving two surgeons performing the parts of the procedure simultaneously (for example, heart transplant).”