Q&A: Using modifier -62 to report and charge for spinal co-surgery

Q: When would it be appropriate to apply modifier -62 (two surgeons) on claims for spinal procedures performed by co-surgeons, and what effect would this have on physician reimbursement?

A: Modifier -62 may be applied when two surgeons work together as primary surgeons and perform distinct parts of the same procedure. Each surgeon would report his or her distinct operative work by adding modifier -62 to the procedure code.

Many physicians work as co-surgeons during complex spinal procedures. Surgeons of different specialties, including neuro-, orthopedic, thoracic, and general surgeons, may perform distinct parts of a spinal procedure. The orthopedic or neurosurgeon typically performs the procedure while the other surgeon performs the approach.

Reimbursement for spinal procedures reported using modifier -62 varies by insurance carrier. Medicare reimburses co-surgery procedures by taking 125% of the approved reimbursement and paying each surgeon 62.5%.

CPT guidelines state that codes for instrumentation, biomechanical devices, and bone graft codes cannot be reported with modifier -62. However, coders may report these services with modifier -80 (assistant surgeon) to indicate that one of the surgeons assisted the other surgeon during the performance of that component of the spinal surgery.

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.

Physician A

Physician B

Editor’s note: This question was answered by Lynn Anderanin CPC, CPMA, CPPM, CPC-I, COSC, senior director of coding education at Healthcare Information Services in Park Ridge, Illinois, during the HCPro webinar, “Spinal Coding Made Simple: Incorporate 2020 ICD-10-CM and CPT Updates.”

This answer was provided based on limited information. Be sure to review all documentation specific to your own individual scenario before determining appropriate code assignment.