Wiki Need help with billing 62141 & 61312

[bkhattak]

Hi,
I work for a plastic surgery clinic. Our doctor did a Cranioplasty along with the the neurosurgeon as a co surgeon on a 63 yrs old. Let's say the date was 12/20. The surgery was in the morning. Late at night the patient developed an epidural Hematoma and they had to do a Craniotomy. The surgery went past midnight. Our Doctor (Plastic surgeon) documented the new date that is 12/21 while the neurosurgeon dated the Craniotomy as 12/20. We billed for two different dates, 12/20 & 12/21. The Insurance asked for the OP notes for both the Surgeons. We already got paid for 12/20 but for 12/21, they are not considering the neurosurgeon notes because it doesn't match the DOS on the claim. We asked their clinic if they can change the date but they said it's gonna be the Hospital & the Hospital said it's supposed to be the Doctor. But the neurosurgeon's biller said that they already got paid for both the procedures so I asked him, If how it's possible because they can't be billed together as per the NCCI edits, His reply was: He billed it on different claim forms for the same date. I am pretty sure it still be considered bundled.

I would really appreciate if somebody can put their insight and expertise.


Thanks
Bilal

 

[ashleybjones18]

Since the procedure began on 12/20 the DOS would be 12/20, so their charges are correct. The second claim should be billed with 78 modifier. There is a possibility for denial, but that is appealable and with proper documentation/well worded appeal this would be overturned.