Coding Corner: Complexities of Coding for Co-Surgeons | Adrianne Mallen, MD
Surgery can often be a team sport. Modifier 62 is used for two separate primary surgeons who are working together. In order for this code to apply, both surgeons are required due to their individual skillset AND the complex nature of the procedure and/or patient condition. Each surgeon must document separate operative notes for the specific procedure, document the co-surgeon’s name, the reason the co-surgeon was needed (medical necessity), and reference the work performed by the co-surgeon in the body of the operative report. An exception for two surgeons of the same specialty working together is if they are performing parts of the procedure simultaneously. A modifier 62 is not required when surgeons perform a different procedure with different CPT codes.
It is important to note that assistants during surgery would require different modifier codes. Modifier 80 is used for an assistant surgeon. Modifier 82 is used for assistance, at a teaching hospital, when no qualified resident is available.
For both co-surgeons and assistants, the codes entered by each surgeon must be the same.
Scenario 1: A septic cervical cancer patient with rectovaginal fistula requires washout and exploration. Gynecologic oncology performs an exploratory laparotomy and biopsies. Colorectal surgery performs a diversion. Both surgeons would document their own operative note and add modifier 62. In each of the operative notes the co-surgeon’s name would be listed and the medical necessity explained. Each of the operative note bodies would reference the co-surgeon’s operation. The codes submitted by each surgeon must be the same.
Scenario 2: Two gynecologic surgeons perform a total pelvic exenteration simultaneously. Surgeon #1 works up top with the exploratory laparotomy. Surgeon #2 works down below for the perineal phase. Modifier 62 applies (even in the same surgical specialty) as both are performing different portions of the procedure simultaneously.
Scenario 3: An ovarian cancer patient is undergoing interval debulking after response to neoadjuvant chemotherapy. Hepatobiliary surgery performs liver wedge resection. Each surgeon would document their own operative note and modifier 62 would not be necessary as there would be different CPT codes for the procedure.
Scenario 4: A gynecologic oncology colleague is assisting in a radical hysterectomy. Modifier 80 would be used for an assistant surgeon, as they cannot be co-surgeons in same specialty. The codes submitted by each surgeon must be the same.
Adrianne Mallen, MD, is a gynecologic oncologist at MN Oncology in Minneapolis, MN.