Wiki Co-surgeon during endoscopy

[bridgettemartin]

Hoping someone has had experience with this.

Our pediatric gastroenterologist scheduled a patient for an EGD, coordinating with one of our adult GI's doc's to do an EUS during the same session.
The peds GI does an EGD with bx (43239). Our other GI doc does the EUS to look specifically at the ampulla and biliary system, when the peds doc is finished (43259).
So two Dr's; same session; different procedures. When I look at modifier -62, sounds like the same CPT codes are reported. I researched CMS and they say no modifier is needed if the CPT codes are different. (Which sounds odd to me, b/c it's the same session - why would everyone get paid full amounts?)
My concern is that 43239 is bundled into 43259. My claims will have the same group tax ID, but different NPI's.
So, should I submit the 43239 with modifier -59? Seems to me if I do that, it says they were totally separate procedures, which they really weren't. What am I missing here?
Thanks!

 

[talitha82]

In this scenario, I wouldn't bill with a -62 modifier, as it's not the proper use of it. That would be more for a surgery that 2 docs did a distinct part of, but were billing the same code (like perhaps a pain pump insertion, with one doc doing one part of it, and another doing the other, and both billing the code for pain pump insertion if that makes sense.) This is a special case, and I think you are going to have to appeal with the insurance and explain the situation. I would code with a 59 modifier- I am not sure if that is the 'right' answer, but that is what I would do, if that helps. Then, if you get a denial, you can explain...?