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RE: [CRN-L] Assistant surgeon

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  • Susan Koprek
    How about assistant surgeons dictating for the primary surgeon? ... From: CRN-L@yahoogroups.com [mailto:CRN-L@yahoogroups.com]On Behalf Of kim handel Sent:
    Message 1 of 4 , Jun 1, 2010
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      How about assistant surgeons dictating for the primary surgeon?

      -----Original Message-----
      From: CRN-L@yahoogroups.com [mailto:CRN-L@yahoogroups.com]On Behalf Of kim handel
      Sent: Friday, May 28, 2010 6:19 PM
      To: CRN-L@yahoogroups.com
      Subject: RE: [CRN-L] Assistant surgeon

      More Billing Strategies for Co-surgeons

      When Medicare and most other payers receive a claim with a -62 modifier, they have a formula for determining reimbursement. They take the fee for the procedural code, multiply it by 1.25 and divide this amount between the two surgeons. So essentially, each surgeon receives 62.5 percent of the amount they would have gotten as the primary surgeon. Although this is a reduction, it is higher than if the surgeons simply had to split the surgery cost. The following steps should be taken to ensure optimum reimbursement for co-surgeries:

      1. Both physicians should write their own operative notes and identify each other as co-surgeons. It is incumbent upon the physician to write as detailed an operative note as possible. A detailed note will give the carrier a more complete picture of how much work was involved and the time frame in which the work was done, thus proving the need for co-surgeons.

      2. Both physicians should use the same ICD-9 codes so that the diagnoses agree. For the procedural codes to be linked appropriately to the diagnostic codes for a co-surgery, both surgeons and/or their staff should confirm with each other which codes are to be used. Although doctors performing different parts of a surgery may link the diagnostic codes to different procedure codes for parts of the surgery not done as co-surgeons, they should list all relevant ICD-9 codes.

      3. Both co-surgeons should submit their own HCFA 1500 forms and provide their own documentation. Co-surgeons of the same specialty need to be especially diligent in detailing not only the work that they performed, but that of the other surgeon as well. Send a hard copy of the operative report along with a letter of explanation detailing the need for the co-surgery.

      I believe that the best way to handle the situation is to contact the [payers] office beforehand about the co-surgery situation, perhaps during scheduling of the procedure and coordination of the surgery, says McClure. Ultimately, billing for co-surgeons will depend on the understanding between the two physicians about who is going to do (and did) what in the operating room, and how they code the surgery. Surgical coders should work closely with their practices surgeons and the staff of the other surgeon to develop a coding game plan for obtaining the maximum ethical reimbursement to which both are entitled, and one that reflects each surgeons unique contribution to the co-surgery.

      Always believe. Your dreams will come true.

      --- On Tue, 5/25/10, Susan Koprek < skoprek@... <mailto:skoprek%40stcloudent.com> > wrote:

      From: Susan Koprek < skoprek@... <mailto:skoprek%40stcloudent.com> >
      Subject: RE: [CRN-L] Assistant surgeon
      To: CRN-L@yahoogroups.com <mailto:CRN-L%40yahoogroups.com>
      Date: Tuesday, May 25, 2010, 9:11 AM

      Any one have any information for me regarding this? Your opinions are appreciated.

      -----Original Message-----
      From: CRN-L@yahoogroups.com <mailto:CRN-L%40yahoogroups.com> [mailto: CRN-L@yahoogroups.com <mailto:CRN-L%40yahoogroups.com> ]On Behalf Of suz_eq65
      Sent: Monday, May 24, 2010 9:54 AM
      To: CRN-L@yahoogroups.com <mailto:CRN-L%40yahoogroups.com>
      Subject: [CRN-L] Assistant surgeon

      Can an assistant surgeon dictate the operative report for the primary surgeon when they are in the same group? Thank you...

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