Wiki 2 seperate physicians

[vickymazza]

Good Morning,

We had a patient that was scheduled for an EGD and a Colon on the same day; however physician A preformed the colonoscopy ( he is a colorectal surgeon ) and physician B preformed the EGD. The patient never left the procedure room. I was hoping that someone would be able to point me in the right direction on what modifier to use and which procedure code would get that modifier. Medicare did reject the EGD with the Modifier 79.

Thank you,
Vicky Mazza

 

[trarut]

Hi, Vicky. What CPT codes were used? And what reason did Medicare give for the denial?

 

[vickymazza]

Hi. We used 45380 and 43235, I put a 79 Modifier on the EGD. The rejection we received from Medicare was *Missing / Incomplete / Invalid HCPS. I have not called them yet to ask them exactly what is invalid. We usually don't have 2 separate providers doing procedures on the same patient, this is all new to me.

 

[thomas7331]

You should remove the 79 modifier - this is not needed and not appropriate since you are not in a post-op global period. There should be no modifier required in this situation, unless you have billed a screening diagnosis code, in which case a modifier PT may be necessary on 45380. 45380 and 43235 are both valid codes and do not bundle or overlap in any way that would require a modifier, and it should not matter that there are different physicians for the two procedures. If the claim continues to deny, I think you will need to contact the payer to find out what the issue is.

 

[vickymazza]

Thank you so much!!! I will take the 79 off and resubmit the claim and wait for a response for Medicare.