Co-surgeons

I just discovered an issue with some co-surgery claims....


So...Each CPT code has an indicator in the Medicare Physician Fee Schedule as follows:

- If the CO-SURG column includes a “1” indicator: You may append modifier 62, but documentation must show which special circumstances or skills required two surgeons to share responsibility.
- If the CO-SURG column includes a “2” indicator: You may append modifier 62 as long as each of the operating surgeons is of a DIFFERENT SPECIALTY.
- If the CO-SURG column includes a “0” or “9” indicator: Medicare does not allow modifier 62 with that code.


Now this the odd part — CPT 43246 is one that our Thoracic surgeons commonly perform as co-surgeons. I just realized this one has an indicator of 2. So I ran a quick report to be sure and Medicare has been paying!!!

What to do now? Do I give the money back? Discontinue billing this way going forward?

Thanks,
Erica
Sign In or Register to comment.