• If this is your first visit, be sure to check out the FAQ & read the forum rules. To view all forums, post or create a new thread, you must be an AAPC Member. If you are a member and have already registered for member area and forum access, you can log in by clicking here. If you've forgotten the password it can be reset on our sign in section by entering your registered Email Address or Username here. To start viewing messages, select the forum that you want to visit from the selection below..

Wiki Aetna 43246-62

Create Wiki
P

Phuff20

Guest
Messages
1
Location
Neptune, NJ
Best answers
0
Hi,

Per Aetna policy they do not reimburse the PEG code with any assist/co surgeon modifiers. Can anyone give suggestions on how to appeal this for payment?

Thank you
 
Hi
Aetna does not believe that modifier 62 is appropriate in this instance even though Medicare Pays.

Aetna sees this modifier as a "Surgery " modifier.

I have billed with Modifier 80 and 81 and still denied Assistant Surgeon.

I bill without Modifier and send notes.

They usually pay after that.

Seems like alot of work but thats what I have to do.
 
They most likely don't think it is an extensive enough procedure to require two surgeons. Do you need 2 surgeons because it is a complicated case? If so, then appeal explaining why you needed two people to place the gastrostomy.
 
You must log in or register to reply here.
Top