Wiki 62 Modifier billing

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deechance

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I have a spine surgeon that used a vascular surgeon for a case. This vascular surgeon is NOT billing for the claim per he is not a provider for insurance, and also does not have a billing system in place. (scratching my head)

My spine surgeon listed him as a co-surgeon on his op note. (not sure if vascular surgeon did a op note, apparently he is new or his office staff is new). We billed to ins with 62 mod, they are saying they wont pay unless they get the vascular surgeons claim. The insurance has a copy of my spine surgeons op note which lists vascular surgeon and co-surgeon...

There is different opinions in the office. One is worried about fraud

My question is this. Is there any legal obligations to my surgeon taking off the 62 mod and submitting a corrected claim?
 
Question: are you able to speak with the billing dept concerning the filing of their claim? They need to file since they are mentioned as "co-surgeon" on your op rep.
Make sure you get name and explanation concerning why and outcome of conversation. This will help you to appeal your denial if needed. Whether the biller/dr is new or out of ntwk they need to politely be informed that this claim needs to be submitted with a 62 mod on it. Speak with a biller supervisor if needed.
Let me know the out come.
Thanks, Lisa Jo Batts, CPC, CMBS.
 
Yes the office manager was contacted and that is the one who told us that they have no billing system and they didn't plan on sending in a bill. Like I said scratching my head... What surgeon doesn't want to get paid... I will have a little chat about getting a plain old typewriter and a HCFA and typing a bill if needs be.. Lol

Thank you for the help :)
 
It will depend on the procedure and the documented need for two surgeons to perform one procedure. Also your providers note needs to indicate at what point of the procedure the other provider stepped in and he stepped out. Even if the other provider does not submit a claim, your note should show that your provider performed only the first or the second part of the procedure. Not all procedure allow for two surgeons so that may be the issue. If the two surgeons performed separate procedures but in the same operative session then you bill only for the procedure your provider performed. What procedure are you trying to submit with the 62 modifier?
 
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