Coding Quandaries – Understanding the Dos and Donts of the -62 Modifier

However, the spine surgeon could have a second spine surgeon assisting who was permitted to use the -80 modifier, which Medicare reimburses at 16 percent of the fee schedule for the appended code. Although Medicare reimburses a code appended by the -62 modifier at 125 percent of the regular payment, this reimbursement is divided equally between the two surgeons, unless coordinated prior written arrangements are made.

There were several concerns raised about the use of the -62 modifier on every code describing an instrumented anterior spinal fusion. For example, the access surgeon may only be present for the exposure and closure, making it difficult to justify “co-surgery” for the instrumentation and graft harvest codes.

In addition, the spine surgeon loses substantial revenue when all the codes are appended by the -62 modifier. Yet, the specialty societies representing the access surgeons raised legitimate concerns regarding “stand-by” time, during which the access surgeon must be available to manage a vascular or visceral injury.

Since Medicare rules prohibit surgeons from performing the key portion of two operations simultaneously, the access surgeons feel restricted from performing any billable services while the spine surgeon is performing the instrumented fusion.

Discussions among the various specialty societies resulted in a plan to develop separate access codes for spinal surgery. An interim solution was offered to change the use of the -62 modifier so that it could only be applied once in a single operative session. However, the -80 modifier could now be used by the access co-surgeon on remaining codes.

These new coding rules became applicable in 1999, and resulted in a reduction in reimbursement for the access surgeon who used the -62 modifier on all the codes in 1998. The new rule also eliminated the opportunity for an assistant spine surgeon to use the -80 modifier

The following chart represents, under 1999 rules, a two-level anterior instrumented lumbar arthrodesis at L4L5 (22558) and L5S1 (22585) performed with iliac autograft (20937) and paired threaded fusion cages at each level (22851 at L4L5 and 22851-59 at L5S1) by a spine surgeon and a general surgeon. A comparison is made with an option under the previous 1998 CPT rules.