If your business is like others, you’ve seen a drastic
increase in your health care costs in recent times. Providing health care
coverage for your employees is costly, and the last thing you can afford is to
pay more than you’re supposed to, due to inaccurate medical bills.
Unfortunately, billing mistakes happen more often than you might think. That’s
why it’s important to educate yourself on how medical billing works so you can
catch these mistakes and ensure they are corrected, saving your company money.
Here’s a simple explanation of how medical billing works.
Whenever a patient goes to the hospital, every service that’s rendered is
documented. Each particular service or procedure has its own CPT (Current
Procedural Terminology) code that’s used to create the claim your company is
supposed to pay. In some cases, modifiers (two-digit codes) are appended to the
CPT codes to recognize that a certain service may have been altered by a
specific circumstance.
The problem is that modifiers are many times misunderstood by
billers. Incorrect modifier usage leads to bills with fees that are higher than
they should be.
One modifier that is sometimes misapplied (or more often, not
applied when it should be) is Modifier 62. This modifier is used to denote that
two surgeons are working together to perform distinct parts of the same overall
procedure. In these circumstances, each surgeon is supposed to bill using
Modifier 62, providing a discounted rate from the physician fee schedule for
the co-surgery. Payment to each surgeon is typically made at 62.5 percent of
fee schedule.
What are some commonly confusing situations related to
Modifier 62?
- When a co-surgeon acts as an assistant during additional procedures performed during the same session, those additional services rendered should be reported with their individual CPT codes using Modifier 80 or Modifier 82.
- Modifier 80 and Modifier 62 should not be used together on the same CPT code for a co-surgery as it’s implied in Modifier 62 that each surgeon will play an equivalent role in performing the main procedure.
- When a bilateral procedure is done by two surgeons of the same specialty, Modifier 62 needs to be used as well as Modifier 50.
- When appropriate, multiple procedure reduction may need to be applied as well as Modifier 62.
- Both surgeons must bill using Modifier 62 when performing co-surgery.
The most common mistake related to Modifier 62 is that one
surgeon will use it and the other won’t, trying to bill the payer for 100
percent of his or her services. That’s erroneous.
Here are examples of correct and incorrect Modifier 62 usage
on a bill for a co-surgery.
Correct:
--Dr.
Johnson, CPT 22556-62, payment made at 62.5 percent of fee schedule
--Dr. Adams, CPT 22556-62, payment made at 62.5 percent of
fee schedule
Incorrect:
--Dr. Johnson, 22556, payment made at 100 percent of fee
schedule
--Dr. Adams, 22556-62, payment made at 62.5 percent of fee
schedule
By instituting a cost containment program that includes
medical bill auditing, your company will be able to catch any billing mistakes
and make certain they are corrected so you aren’t spending more than necessary.
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