by Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content
May 11th, 2015
Some surgeries require the expertise of more than one surgeon or may require the assistance of another surgeon to ensure adequate care is given and the surgery is a success.
Let's review a couple terms:
Co-Surgeon: When two surgeons act as primary surgeon for a specific procedure. Each acts as the primary surgeon at different points of the surgery.
Assistant Surgeon: When a primary surgeon requires the assistance of a second surgeon to help (assist) him/her complete the surgery.
When co-surgeons perform a surgery, generally each is responsible for performing a portion of the surgery while the other assists. Assisting each other is considered an incidental part of the co-surgeon's responsibilities for the specific procedure in which they are co-surgeons.
To report Co-Surgeon status on a CPT code, append modifier 62.
When a surgeon requires the assistance of another surgeon during a surgery, one acts as a primary surgeon while the other is in attendance to assist. Generally the primary surgeon will contact another surgeon (usually the same specialty) to assist in the surgery.
To report Assistant Surgeon status on a CPT code, append modifier 80 or 82 (you'll have to review the difference in these two modifiers so you will know which is appropriate for your situation.
Many surgeries are made up of multiple smaller surgeries performed during the same surgery session and each one is represented by an individual CPT code.
Not all of the surgeries performed during a single operative session require a co-surgeon or even an assistant surgeon. Additionally, not all CPT procedure codes require or are even approved for a co-surgeon or assistant, in which case if you use one the insurance may not pay for their service.
Only append modifiers, 62, 80, or 82 to the CPT codes where applicable.
If your physician is scheduling surgery and requests a co-surgeon or assistant, you can easily find out if the CPT code allows for it:
1. Type the CPT code in the search bar in Find-A-Code.
2. Open the plus (+) symbol under 'Additional Code Information
(Global Days, MUEs, etc.)'
3. Look for:
Assistant Surgeon (80,82)
Team Surgery (66)
There is a status indicator listed next to each
‘0’ indicates it will not be paid
‘1’ indicates it may not be paid
‘2’ indicates that that it may be paid
If the surgery you are performing does not state it approves of a co-surgeon or assistant but your provider feels that the circumstances warrant it, you may submit documentation that supports this either postoperatively or better yet, preoperatively. Additionally, the operative report should clearly document the need for the assistant or co-surgeon and explain what they did during the surgery that warranted the need for them. Medical necessity is of utmost importance.
One more thing, you will want to be sure to have the billing staff coordinate claim coding and submission with the co-surgeon and/or assistant surgeon’s office to avoid reimbursement issues and/or insurance denials. Making sure the correct modifiers are reported on each CPT code is imperative to proper reimbursement.
Many billers/coders do not understand how this works and therefore submit incorrect information causing a denial to occur.