Wiki Bi-lateral 27447 w/ 2 docs

[Jan Dalton]

We have been submitting 2 claims (1 for each doc) one pays the other gets denied for dup help

The Drs are from the same group. One Dr does sx on lt knee, the other does sx on rt knee. we have tried rt on one claim and lt on second claim, dupl.

 

[DOVERRED]

for a lack of info i suggest try looking at modifiers 62 and 80

 

[cpccpma]

Did the docs assist eachother on each side? Or did one doc do the entire sx on one side and the other doc did the entire sx on the opposite side? If so, are they from the same practice? What about billing the first with rt modifier and the 2nd with 58-lt modifier (separate claims)? I'm just thinking out loud.....

 

[mitchellde]

I am wondering if the only modifier needed here is the Lt on one claim and the RT on the other. It could be that simple.

 

[KilgoD]

Just a thought

Remember you must give the complete picture so make sure modifiers are correct & if this is claim that is being auto adjudicated with the same tin, the computer automatically denies it. Without modifiers or different tins the payment system will not recognize it as 2 separate claims.

 

[pkidd]

27447

Another thought or 2:

1. 27447-50 ?

2. Submit a brief letter of explanation to the payer, citing each MD performed the arthroplasty on either the RT or LT leg. Each worked on one leg and did not assist each other. Send documentation.

3. Code each separately using Mod-62 on each claim. You would probably need to contact the payer to check whether it accepts that modifier.

Good luck!
pat kidd, cpc

 

[cpccpma]

I think appending a 58 on the 2nd surgeons claim telling the insurance company-this is not a dup-this was in fact a planned procedure. You may still have to appeal but being that you have 2 separate claims with different surgeons, the modifier should do the work. Just my thoughts.

 

[Jan Dalton]

Thanks for everyones input, keep it coming

 

[cpccpma]

Also.....if you do append a 62 you would need 2 op reports for each knee as you would have to justify who did what. And does the procedure allow a 62 modifier? (thanks to my offline coder peeps-they helped me with this one!) Hope this helps.

 

[benavej]

Solution: From Insurance Co.

What "Pkid" addressed is correct. Indicate modifiers RT & LT with modifier 62 on each claim with 2 seperate OP reports. That should get your your claim paid.

 

[cpccpma]

If you append the 62 modifier the claim will still be denied for invalid modifier as 27447 does not allow this modifier.

 

[mitchellde]

Agreed and the 62 will reduce each physicians reimbursement to 62.5% of the allowable.

 

[Tanya.DeSimone]

I don't agree with the -62 modifier.

If one is truly doing the left and another the right. I'd go with 27447-LT for one doc and 27447-59-RT for the other.