Saturday, August 28, 2010

Two surgeons perform a specific procedure - Modifier 62

Modifier 62 Fact Sheet

Definition:

• Two surgeons (each in a different specialty) are required to perform a specific procedure

Appropriate Use:

• If two surgeons (each in a different specialty) are required to perform a specific procedure, each surgeon bills for the procedure, and both surgeons need to report the same surgery code with the modifier 62. If one surgeon bills with a modifier “-62,” and one surgeon bills with no modifier. The claim with the modifier suspends for review or will deny. Documentation of the medical necessity for two surgeons is required for certain services identified in the MPFSDB. Global surgery rules apply to each of the physicians participating in a co-surgery.

• Reimbursement is at 62.5% of the global surgery fee schedule amount for co-surgeons.

• The following MPFSDB indicators identify services for which two surgeons, each in a different specialty, may be paid:

0 = Co-surgeons not permitted for this procedure.
1 = Co-surgeons may be paid if supporting doumentation is supplied to establish medical necessity.
2 = Co-surgeons permitted. No documentation is required if two-specialty requirement is met.

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