Wiki Aetna 43246-62

Phuff20

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Neptune, NJ
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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.
 
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