Wiki PEG placement denials

[Leanne]

We bill for a general surgeon who does the gastrostomy tube placement while another doctor performs the endoscopic portion. We're having trouble getting paid for these. We bill 43246 with mod 62 and they deny stating services have already been paid to another provider. Has anyone else been having this problem, or has suggestions on how to bill a different way?

Thanks!

 

[cmartin]

You are billing correctly - it sounds as though perhaps the endoscopist isn't. Check with their office(s) to make sure that they are also using the -62 modifier.
C.Martin CPC,CGSC

 

[FTessaBartels]

Appeal

Even if the other provider IS using the -62 modifier, you might still get a denial.

Just appeal with a copy of your operative note (and a copy of the other doctor's note as well, if you can get it).

Your op note should indicate that your doctor was a co-surgeon with Dr Endocsopist (and Dr E's should state co-surgeon with your doctor). And then clearly state what portion of the procedure your doctor performed.

Our general surgeons will open and close for anterior spinal fusions where both the Orthopaedic surgeon and our surgeon will code the same arthrodesis with -62 mofidier ... even when we send them out together, we frequently get one of them denied as "duplicate." It just takes follow-up.

Good luck

F Tessa Bartels, CPC, CEMC