2 Surgeons

johnithomas

Networker
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36
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Can someone tell me how to bill a surgery when it is done by 2 Surgeons? I have billed the claim to UHC, it clearly states with 2 different names and 2 different procedures, but UHC paid for one procedure, and is now stating that the second is a dup (already processed), and are not paying!!????
 
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164
Location
San Diego
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Hi,

I think that the procedure probably needs a modifier but I'm not sure what you mean by "two surgeons".

Were your docs "co surgeons"? = Modifier 62

Was it an "assist"? = Modifier 80
 

dsg862

Guest
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11
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None Joined yet,
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The first thing to check is if that particular CPT allows an assistant surgeon. I assume you mean assistant, Mod 80. I usually check with the McKesson tool on Aetna website in Navinet and Medicare as a first stop. If you find that the major resources allow the combo of codes (multiple surgery & Modifiers) You'll have a leg to stand on when talking with claims at UHC. Sometimes at the Insurance end they don' see the Mod. 80 depending on their editing platform.
Deena
 

johnithomas

Networker
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36
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Surgery to be preformed was 58660 but the OBGYN after taking alook realized that 44180 had to be done first so he called in the General Surgeon to do the 44180, and then the OBGYN did 58660. Both codes are for Adhesions but in different areas which is why the General Surgeon was called in. One surgeon did their own procedure, they did not assist on the same. Would I still use an 80 modifier?
 
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164
Location
San Diego
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Hi,

I hadn't heard that ASC could not use modifiers 62 or 80. I'm not sure if there are restrictions on these.

As for the surgeries - you are billing for the physician/professional services not the facility, right? I'm just stumped...if you are billing totally different cpt codes and with different provider #'s, I can't think of what the reason for denial from the payor is. Duplicate? How is it duplicate if everything is different? Have you tried calling the payor/appeal line and asking a rep for clarification on their denial?

I wish I could be of more help...you must be so frustrated!:mad:

Good Luck!
 

johnithomas

Networker
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36
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I am billing the facility fee. I was trying to aviod calling UHC they are the worst, but I have no choice.....thanks
 

mbort

True Blue
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2,338
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ENGLEWOOD/DENVER
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80 & 62 modifiers are not valid in an ASC setting. In the ASC you are billing for the facility. Those are practionioner modifiers. The modifiers that are valid for ASC's are on the inside front cover of the CPT code book in the right sided column.
 

sdyches

Guest
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17
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Augusta chapter
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Make sure to add the 80/whichever is applicable to let them know there was another surgeon. Check the CCI edits to see if that procedure allows a Assistant surgeon.
 

aleach

Contributor
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15
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Knoxville, Tn Chapter
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I work in an ASC and I don't use a modifier. I just put the 2nd surgeon in as assistant surgeon for the cpt code that he performed. Hope this helps get your claim paid.
 
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