What Is Modifier 62 and How Is It Used in Medical Billing?
Gain clarity on medical billing for complex surgical procedures involving shared physician responsibilities, ensuring proper coding and payment.
Medical coding describes healthcare services and procedures. CPT (Current Procedural Terminology) modifiers add specific details to medical codes, clarifying services rendered. These modifiers are typically two characters, numeric or alphanumeric, appended to a CPT code to convey additional information affecting claim processing. Modifier 62 is a CPT modifier used in surgical scenarios, indicating two surgeons collaborated on a single procedure. Its proper application ensures accurate communication between healthcare providers and insurance payers.
Understanding Modifier 62
Modifier 62, designated “Two Surgeons,” signifies co-surgery where two primary surgeons work together on the same patient during a single operative session. This modifier is used when each surgeon performs distinct, yet interrelated, parts of a single procedure. This often involves different specialties, where each surgeon contributes specialized expertise to different components of the operation.
For co-surgery to be appropriate, both surgeons must contribute significantly to the procedure. They each perform different components that require their specific skills, rather than one acting simply as an assistant. The concept emphasizes shared responsibility for the surgical procedure. While distinct, the parts performed by each surgeon must be interrelated to a single CPT code.
Applying Modifier 62
Modifier 62 is used for complex procedures requiring the expertise of two primary surgeons. This typically occurs when different specialties collaborate to perform distinct parts of a single surgical procedure. Both surgeons must be present and actively participate during the common portions of the procedure, each performing their specialized components. For example, in a complex spinal fusion, a neurosurgeon might perform the neural decompression while an orthopedic surgeon handles the bone grafting and instrumentation. Another instance could involve a general surgeon providing exposure for a deep abdominal or pelvic procedure, while a urologist performs the definitive urological repair.
Modifier 62 differs from situations involving an assistant surgeon or multiple procedures performed by the same surgeon. It is not used when one surgeon is merely assisting another; assistant surgeon modifiers (like 80, 81, 82, or AS) are used in those cases. If two surgeons perform entirely separate procedures on the same patient, even during the same operative session, Modifier 62 is not applicable. In such cases, each surgeon would bill their respective procedure codes without this modifier.
Documentation for Modifier 62
Comprehensive documentation is essential when Modifier 62 is used. Each co-surgeon must prepare and maintain their own separate operative report. These individual reports should clearly detail the distinct roles and specific portions of the procedure each surgeon performed. The documentation must explicitly indicate that the case was performed as a co-surgery and identify the name of the co-surgeon involved.
A concise statement of medical necessity supporting the need for two surgeons should be included in each operative report. This justification explains why the complexity of the procedure or the patient’s condition necessitated the skills of both primary surgeons. The records should also demonstrate that both surgeons were present and actively involved during the procedure. Any pre-operative planning or consultation notes that further support the decision for co-surgery should also be maintained in the patient’s medical record to substantiate the claim.
Billing and Reimbursement with Modifier 62
When billing for co-surgery, both surgeons submit claims using the same procedure code with Modifier 62 appended. This signals to the payer that two surgeons collaborated on the reported service. The CMS-1500 claim form is used for professional services, and both surgeons’ claims must agree on the procedure code and the application of Modifier 62 to avoid processing delays or denials. Both surgeons must link the same diagnosis code to the common procedure code.
Reimbursement for procedures billed with Modifier 62 typically involves a modified payment methodology. For instance, Medicare and many other payers reimburse co-surgery at 125% of the fee schedule amount for the single procedure. This total allowed amount is then divided equally between the two co-surgeons, meaning each surgeon receives 62.5% of the global surgical fee schedule amount. If additional procedures are performed during the same operative session, multiple surgery guidelines may apply to those separate services.