My provider was on call at a facility and looks like he saw a pt for initial consultation. The next day he assisted in surgery for this pt. Aetna denied the 99254 as global and the 49204 reason denial is N674-Not covered unless a pre-requisite procedure/service has been provided and also B15-This service/procedure requires that a qualifying service/procedure be received and covered. The qualifying other service/procedure has not been received/adjudicated. Looked in cpt book but doesn't state anything should be done additional for this surgery. I am thinking its the pts policy and coverage but rep told me just to send medical records. Any idea what this pre requiste procedure/service could be?
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Wiki 99254 initial consultation and next day 49204 surgery with mod 80 denied
- Thread starter ALozano25
- Start date
toplati
Guest
Hope this helps
An Evaluation and management code with the modifier for decision for surgery should apply when a consultation results in next day surgery. The two surgeons modifier should also apply unless the operative report specifically indicates otherwise.
An Evaluation and management code with the modifier for decision for surgery should apply when a consultation results in next day surgery. The two surgeons modifier should also apply unless the operative report specifically indicates otherwise.
mitchellde
True Blue
the two surgeons modifier (62) would only apply if they were co-surgeons it is not the same as an assistant surgeon.
Co-surgeon is when two surgeons are performing distinct and separate parts of the same surgery. each surgeon must dictate a separate operative note detailing their part of the surgery and at what point it was handed off/received.
Co-surgeon is when two surgeons are performing distinct and separate parts of the same surgery. each surgeon must dictate a separate operative note detailing their part of the surgery and at what point it was handed off/received.