I have a dilemma with a commercial insurance carrier in regards to a denial we keep receiving for 2 different specialists providing consults on the same day. I work for a Multi-Specialty Group and we had a General Surgeon and a Gastroenterologist perform consults on the same day. The General Surgeon has been paid, the denials all revolve around the GI Specialist. At first the insurance carrier denied the GI doc as a "duplicate" charge. We appealed with consultatoin notes from the hospital and this time we received a denial stating that we need to "submit a revised claim form with the accurate modifier information."

We can not figure out what modifier the carrier may be asking for and they are not offering any suggestions. After doing some research on the internet, I have very few reliable sources. The one I did find suggested using HCPCS modifier AF - Specialty Physician.

Does anyone have any suggestions?

Heather MacPherson, LPN, CPC, CPC-H