S2068 and modifier 62

pmcs1776

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Hello,

I started using S2068 instead of 19364 for a DIEP Flap Breast reconstruction. I have two surgeons in my office that are CO - surgeons for this procedure. I just received an EOB from UHC stating that modifier 62 cannot be used with S2068. I looked it up on Encoder pro and it is saying the same thing. Does anyone know why or how to get around it? It also says I cannot use modifier 80 as an assistant. Any insight would be appreciated.

Thanks,
Maria
 

jthelen

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S2068 and modifier

Maria,

Have you been able to bill an assistant surgeon with the S2068 code yet?? If not, are you using the 19364 or just not charging for an assist? We are having this same concern with Medica and I believe they are related to UHC. Without an assistant, this procedure would be considerably longer which would only increase the cost of an anesthesiologist plus operating room cost. We still feel this code best describes the expertise of the procedure which why we haven't change to 19364
Thank you Joan
 
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S2068 and Tricare

We were able to obtain reimbursement using S2068, including the assistant and cosurgeon. However, effective Feb 2016 Tricare has posted a No Pay List which is now excluding the S2068 all together. This procedure is really not the 19364. Has anyone else been able to locate a new code which is consistent to S2068? thanks!
 
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