Using modifier-62 to report and charge for co-surgery should be completed using the CPT guidelines for usage. Continue reading below for more information as well as an example of how a procedure would be adjudicated by co-surgeons.
A patient has been seen in the clinic for recurrent large central/right herniation of L4-L5. Surgery was discussed, risks explained, and consent signed by the patient. This surgery is complex and requires two surgeons to complete the procedure.
Modifier -62 states: When 2 surgeons work together as primary surgeons performing distinct part(s) of a procedure, each surgeon should report his/her distinct operative work by adding modifier -62 to the procedure code and any associated add-on codes(s) for that procedure as long as both surgeons continue to work together as primary surgeons. Each surgeon should report the co-surgery once using the same procedure code. If additional procedure(s) (including add-on procedure(s) are performed during the same surgical session, separate code(s) may also be reported with modifier 62 added. Many physicians work as co-surgeons during complex procedures.
Different specialties may perform distinct parts of a procedure. One may perform the procedure while the other surgeon performs the approach. Medicare reimburses co-surgery procedures by taking 125% of the approved reimbursement and paying each surgeon 62.5%. Other carriers may vary slightly, it is best to check with your specific payer for their contracted rates.
The following example shows how a spinal procedure performed by co-surgeons would be adjudicated based on CPT guidelines for the use of modifier -62.