Modifier 62 denial

Chelsea1

Networker
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90
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0
Hi,

I code for a cardiologist who also does peripheral vascular procedures. This physician also works with a vascular surgeon from another group on some of these procedures together. I am amending a 62 modifier to the primary code however I am getting denials on that code/modifier combination. The rest of the claim gets paid. I am wondering if I should be adding a 80 modifier instead? Any suggestions would be greatly appreciated.
Thanks!!!!!
 

thomas7331

True Blue
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2,245
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CMS attaches a co-surgeon and an assistant surgeon indicator to all CPT codes which identifies whether or not a co-surgeon is allowed for that particular procedure. You can look these up on the CMS Medicare web site under the Physician Fee Schedule. Procedures that do not normally require a co-surgeon or assistant surgeon will not be paid, although for some codes, you can receive payment if documentation supports the medical necessity of the additional provider. Most commercial payers follow the CMS guidelines on this. In addition, in order to bill for a co-surgeon, both physicians must dictate a report and both must bill the same CPT code and both with the 62 modifier. If one physician does not bill the modifier, and is paid, it is likely that the second claim billed with a modifier 62 will be denied.
 

Chelsea1

Networker
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90
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0
Modifier denial

Thank you so much. That information helps. I will get on the Medicare website!!!!!
 
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1
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Hello,
I have a follow-up question. Can the primary surgeon and the assistant surgeon be billed under the same NPI? Does the assistant surgeon have to submit a claim under their own NPI?
 
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257
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Selden
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The assistant surgeon needs to submit the claim under their own name/NPI. They may have the same TID, or work for the same group, but you can't bill that the assistant surgeon was the primary surgeon.
 

RDK720

Networker
Messages
52
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Hi,

I code for a cardiologist who also does peripheral vascular procedures. This physician also works with a vascular surgeon from another group on some of these procedures together. I am amending a 62 modifier to the primary code however I am getting denials on that code/modifier combination. The rest of the claim gets paid. I am wondering if I should be adding a 80 modifier instead? Any suggestions would be greatly appreciated.
Thanks!!!!!

Hi. What is the procedure code?
 
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