Wiki PEG Tube Placement-CoSurgeons

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Tara0513

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When GI doc does an EGD with PEG placement, GI doc is doing the upper endoscope and they call in a surgeon (from different practice) to perform the placement of the PEG. I usually code 43246 with modifier 62 for my GI doc. Lately we have been receiving denials, and the surgeons office has been calling asking why we have billed with the 43246 code and not just a straight EGD. I have explained that the 43246 incorporates the EGD, but now I am doubting myself. Can someone please help and let me know if I am billing correctly or is there another way to bill for the EGD with PEG placement with 2 physicians from different specialities?

Same scenario only difference one of my GI groups calls in another GI from same group to perform the PEG placement while the one GI performs the EGD, do I bill both GI's with 43246 modifier 62? Or do I use modifier 80?

Any help would be greatly appreciated!!!
 
I think you are doing this correctly - both the surgeon and GI specialist should bill the same code with the co-surgeon modifier. This is the way we did it in the practice where I previously worked and we rarely had issues, but I'd expect it would become problematic if the two physicians are not billing the same codes.

As far as two physicians of the same specialty doing this - I haven't encountered this but think you'll want to review your payer guidelines. I believe some payers require co-surgeons to be of different specialties, in which case I think the assistant surgeon coding might be more appropriate.
 
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