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Wiki Missed Abortion Coding D & E

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dlhoffman1974

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Having a problem getting D&E paid, anyone have success getting more than one paid on the same patient when they are done several days apart? I am using the 78 modifier with the code 59812, but a different doctor did the surgery the second time. Not sure why they are not paying, they say it goes against the CMS guiidelines? Is this true even with 2 different providers? Should I use a different modifier? Any help would be appreciated I am kinda new to this, thanks!
 
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This isn't my specialty, but I'm willing to offer a couple of thoughts on it since no one else has. Although you might consider posting it in the OBGYN area of the forums to find the experts.

-Was sepsis due to retained products mentioned? If so that is a different CPT.
-Consider if it was done for the same condition as the original surgery (modifier 58), or if there was a complication (modifier 78).
 
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