Wiki Medicaid Denial with cosurgeries

[coder25]

We recently were denied payment from Medicaid for a cosurgery which we did with a gyn/oncology surgeon for pelvic exonoration, b/l salpingo-oophorectomy, and bowel resection. According to Medicaid, they will only allow one surgeon payment, despite having a 62 modifier on it and send along the two OP notes.

Has anyone else ever experienced this? Is there is way to appeal this to get them to pay our surgeons?? We have no problems getting payments from either Medicare or other insurance companies.

Thanks in advance!

Peggy

 

[FTessaBartels]

What state are you in?

Medicaid reimbursement varies by state.

Due to our location and specialty, we get patients from other states. Some Medicaid payers will ONLY pay one physician per day, so whoever gets their bill in first gets paid. We work with the various other specialties to ensure that the highest RVU bill is the one that gets in first, and we "share" the meager payment on the back end.

Not the answer you were hoping for, I'm sure, but them's the breaks.

F Tessa Bartels, CPC, CEMC

 

[coder25]

Thanks for responding Tessa!

I am from PA which apparently is denying any cosurgeries. It just isn't fair that both surgeons are not getting paid for the work that they are doing, even if it is a small amount.