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2 Surgeons

  1. Default 2 Surgeons
    Medical Coding Books
    Can someone tell me how to bill a surgery when it is done by 2 Surgeons? I have billed the claim to UHC, it clearly states with 2 different names and 2 different procedures, but UHC paid for one procedure, and is now stating that the second is a dup (already processed), and are not paying!!????

  2. #2
    Default
    Hi,

    I think that the procedure probably needs a modifier but I'm not sure what you mean by "two surgeons".

    Were your docs "co surgeons"? = Modifier 62

    Was it an "assist"? = Modifier 80
    Sylvia Thompson, CPC
    Billing Supervisor
    San Diego, CA

  3. #3
    Location
    None Joined yet,
    Posts
    11
    Default 2 Surgeons
    The first thing to check is if that particular CPT allows an assistant surgeon. I assume you mean assistant, Mod 80. I usually check with the McKesson tool on Aetna website in Navinet and Medicare as a first stop. If you find that the major resources allow the combo of codes (multiple surgery & Modifiers) You'll have a leg to stand on when talking with claims at UHC. Sometimes at the Insurance end they don' see the Mod. 80 depending on their editing platform.
    Deena

  4. Default
    Surgery to be preformed was 58660 but the OBGYN after taking alook realized that 44180 had to be done first so he called in the General Surgeon to do the 44180, and then the OBGYN did 58660. Both codes are for Adhesions but in different areas which is why the General Surgeon was called in. One surgeon did their own procedure, they did not assist on the same. Would I still use an 80 modifier?

  5. Default
    and I didnt think ASC could use 80 or 62 modifiers?

  6. #6
    Default
    Hi,

    I hadn't heard that ASC could not use modifiers 62 or 80. I'm not sure if there are restrictions on these.

    As for the surgeries - you are billing for the physician/professional services not the facility, right? I'm just stumped...if you are billing totally different cpt codes and with different provider #'s, I can't think of what the reason for denial from the payor is. Duplicate? How is it duplicate if everything is different? Have you tried calling the payor/appeal line and asking a rep for clarification on their denial?

    I wish I could be of more help...you must be so frustrated!

    Good Luck!
    Sylvia Thompson, CPC
    Billing Supervisor
    San Diego, CA

  7. Default
    I am billing the facility fee. I was trying to aviod calling UHC they are the worst, but I have no choice.....thanks

  8. #8
    Location
    ENGLEWOOD/DENVER
    Posts
    2,338
    Default
    80 & 62 modifiers are not valid in an ASC setting. In the ASC you are billing for the facility. Those are practionioner modifiers. The modifiers that are valid for ASC's are on the inside front cover of the CPT code book in the right sided column.

  9. #9
    Location
    Augusta chapter
    Posts
    17
    Default
    Make sure to add the 80/whichever is applicable to let them know there was another surgeon. Check the CCI edits to see if that procedure allows a Assistant surgeon.

  10. #10
    Location
    ENGLEWOOD/DENVER
    Posts
    2,338
    Default
    Just FYI, The 80 modifier is not valid on an ASC claim, the 80 modifier is for surgeons, not facility use.

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