Wiki 27447 by 2 different docs same surgery time

[cward267]

BCBS is denying the claim when it's billed out on 2 claims - here is the note I received;

Good morning! I need another opinion...we have two ortho docs who will each perform a total knee replacement on a patient. One doc does the left and one doc does the right. What would be the appropriate modifier for this circumstance? The coder/charge entry person at the hospital has started using a 62 mod and insurance does not like that. Is 77 the right mod?


Any ideas?
I was asked this question by a colleague and feel if it's billed as
27447 - RT, Dr. One
27447 - LT, Dr. Two
this should be paid with report attached

 

[nyyankees]

BCBS is denying the claim when it's billed out on 2 claims - here is the note I received;

Good morning! I need another opinion...we have two ortho docs who will each perform a total knee replacement on a patient. One doc does the left and one doc does the right. What would be the appropriate modifier for this circumstance? The coder/charge entry person at the hospital has started using a 62 mod and insurance does not like that. Is 77 the right mod?


Any ideas?
I was asked this question by a colleague and feel if it's billed as
27447 - RT, Dr. One
27447 - LT, Dr. Two
this should be paid with report attached

did they help each other? If not then 27447-RT and 27447-LT as above would be correct. But I can see how the carrier would want to deny as I'm not sure how many times this has happened. Did patient see 2 separate docs - 1 for each knee? Doubt it.

 

[radar]

I have billed to Anthem 27447 62 RT for one doctor and 27447 62 LT for the other doctor , drop to paper claims and submit op report and I have been paid for both surgeons

 

[mitchellde]

I have billed to Anthem 27447 62 RT for one doctor and 27447 62 LT for the other doctor , drop to paper claims and submit op report and I have been paid for both surgeons

This is not correct usage of the 62 modifier. Each provider performed a separate procedure, the 62 is used when 2 surgeons perform different parts of the same surgery. If both surgeons practice in the same off then it should not be two separate claims it is billed on one claim both surgeries using the RT and LTodifiers and the corresponding NPI in 24j. If these are two separate practices the you will need to appeal

 

[caromissunc1]

It would be interesting to try perhaps a 66. It is 2 different surgeons in two different areas. Since they are working two separate anatomical areas. Since it is 2 orthopods working together, is it safe to assume that they are working under the same NPI? However, is the patient going to see both doctors post-op for the 90 day global? I also agree with the paper claim and OP note. Hmmm..... interesting...