4 Coding Rules for Multi-Provider Modifiers

Posted on 26. Sep, 2009 by Editor.

Check the work, not dictation, to prevent 42% or more in losses.

With carriers paying 62 percent on co-surgery cases, 20 percent on assistant surgeries, and 15 percent for non-MD assistants, the wrong modifier can cut your pay big time — meaning you better keep certain rules in mind.

The hang-up: “Choosing between the co-surgery and assistant surgeon modifiers can be a confusing matter because physicians often do not understand the difference themselves,” says Beth Thomsen, department billing coordinator for Neurosurgery/Plastic and Reconstructive Surgery with University of Toledo Physicians LLC. “One surgeon may dictate an operative report as though it’s a co-surgery, but the supposed co-surgeon feels that he or she acted as an assistant only.”

Solution: Focus on what the physician did during the case and the physicians’ coordination and documentation, Thomsen recommends. Read on for tips on ensuring the surgeon’s work – not his dictation — leads you in the right direction every time.

1. Analyze Each Provider’s Responsibilities

Encourage your providers to clearly document their roles so you’ll know how to report the case. The simplest way to approach your coding is to treat each physician’s portion as a separate procedure.

Continue Reading

Mind Your Modifiers When Your Surgeon Works With Others

Posted on 16. Feb, 2009 by Editor.

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.

AUDIO CD: Two-fers! How to get paid for co-surgery and surgical assistance.

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,

Continue Reading