Was the procedure code billed with a 62 modifier? If so check your status indicators on that specific code, and verify if a co-surgeon is allowed. If it is not allowed i am assuming that is your denial reason, and you would not be able to bill with 62 modifier. Only the main surgeon is billable.
the modifier is billable. A General Surgeon performs our access. I have found out that the state of KY put in a policy denying all payment modifiers as of 04/10 and now all HMOs are following. This is a nightmare. I am in the process of contacting my state rep to get better clarification. I am curious if they have created their own modifiers for these scenarios. If not, I don't know how payers will adjust appropriately. Thank you.
The Policy, they sent me is below:
Kentucky: The state of Kentucky does not reimburse modifiers 81,82, AS, 52, 53, 62, 66, 22, 63, 54, 55, 56, and
JW. Kentucky will be excluded from polices that reference modifiers 81,82, AS, 52, 53, 62, 66, 22, 63,
54, 55 and/or 56.
