Aetna 43246-62

Phuff20

New
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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
 

surfergirl

Networker
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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.
 

cgaston

Expert
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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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