May 17, 2018
Continuing the review of new upcoming claims edits published in the March 15 Provider News, some of the next set of edits will become effective with claims processed on and after June 15, 2018. These edits will include the following:
Modifier 62 – Two Surgeons
Modifier 62 is appended to a service when two surgeons work together as primary surgeons performing distinct part(s) of a single procedure. It’s critical that each surgeon reports their own distinctive part of the operative work in their operative notes. The claims for each surgeon should include Modifier 62 on the same procedure code that’s billed by both surgeons. If a physician is actually assisting the other provider as part of the operative procedure, Modifier 62 shouldn’t be used and Modifiers 80/81/82 are more appropriate.
To determine whether a surgical procedure allows for co-surgeons, check the co-surgeon indicator on the CMS National Physician Fee Schedule Relative Value Guide. The flags indicate:
- 0 = Co-surgeons not permitted for the procedure
- 1 = Co-surgeons may be paid; supporting documentation required
- 2 = Co-surgeons permitted; documentation not required
- 9 =Co-surgeon concept does not apply
Additional information can be found in the Modifier 62 Payment Policy. Along with enforcing the co-surgeon flag, theses co-surgeon procedures, when done in multiples, will also be subject to applicable multiple procedure reductions.
Modifier 90 – Reference (Outside) Laboratory
We’re expanding the Modifier 90 Payment Policy to include Washington providers who render laboratory services. The provider who actually performed the lab test must submit laboratory services directly to us. We’ll directly reimburse the laboratory that performed the lab service(s) (for those lab services covered by the member’s benefits). We’ll no longer reimburse modifier 90.