Mind Your Modifiers When Your Surgeon Works With Others

Posted on 16. Feb, 2009 by Editor in Hot Coding Topics

Automatically appending modifier 52 could be costing you hundreds.

When your surgeon works with another physician during a procedure, you can face major coding challenges. If you don’t coordinate your coding with the other physician’s coder, both doctors could lose money and face audits.

Learn how to correctly code for these shared procedures with this real-world case study.

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Review the Surgical Case

Scenario: A urologist and a general surgeon performed surgery on a patient. The urologist did the orchiopexy and performed the opening and closing. The general surgeon performed an inguinal hernia repair.

Coding dilemma: Which codes should each physician report, and what modifiers should the coders use, asks Betsie Wilson, CPC, professional fee coordinator and charge capture surgery team lead at University of Washington Physicians in Seattle, who presented this case study.

No Bundle Means Two Codes

CPT and the Correct Coding Initiative (CCI) do not bundle the two procedures together. In fact, if your general surgeon performed both the hernia repair and the orchiopexy without another physician, you would report both procedure codes.

For this case study, each physician will report his portion of the procedure. You will report the appropriate inguinal hernia repair code — such as 49500 (Repair initial inguinal hernia, age 6 months to younger than 5 years, with or without hydrocelectomy; reducible) or 49505 (Repair initial inguinal hernia, age 5 years or older; reducible). The urologist’s coder will report the applicable orchiopexy code (54640, Orchiopexy, inguinal approach, with or without hernia repair).

Expert Opinions Diverge on Modifier 52

As for deciding whether to attach modifier 52 (Reduced services) for your general surgeon in this case, you’ll need to...

Tags: 49500, 49505, 54640, assistant surgeon, co-surgery, hernia repair, modifier 52, modifier 53, modifier 62, modifier 80, orchiopexy