Forum - Questions & Answers

Feb 19th, 2016 - LBAROGIANIS 250 

Urgent! Need help

Patient had CPT® 62165 done the day before. Then the next day there was a hemorrhage in the resection cavity. Dr. took back the patient to evacuate the hemorrhage. He did the same approach. We billed CPT® 62165 with Modifire 52. Careplus denied stating we never removed tumor the next day. I said your correct, however, that is why we billed with modifier 52.

Any one have any thoughts on this scenerio? I don't have much time to resent out corrected claim.

Thanks in advance!

Feb 19th, 2016 - cmgmr 4 

re: URGENT! NEED HELP

Is modifier 78 a possibility? Per CPT® "Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period".

I am not 100% certain on this as this is not my area of "expertise".

Feb 19th, 2016 - codinqueen 57 

re: URGENT! NEED HELP

62165-52 or any other modifier (like 78) would not be correct for the 2nd day claim because tumor was not removed the 2nd day. Since I don't know exactly what your MD did the 2nd day, I can only make a suggestion, but I might use 64999 with a mod 78. Modifiers are not usually used on unlisted CPT® procedures, but I would use it here and send the corrected claim with a Keep It Socially Simple (KISS) appeal letter and the op rept, with all documents signed by the MD. If he ligated a bleeding vessel or anything else, you could code that as well. I don't code this type of procedures, but hope I can help somewhat with my over 25 yrs of coding experience. Good luck.

Feb 19th, 2016 - LBAROGIANIS 250 

re: URGENT! NEED HELP

I did use modifier 78. Per surgeon, he did the same endoscopic approach, the only thing is that he did not excise tumor, he evacuated hemorrhage.



Home About Contact Terms Privacy

innoviHealth® - 62 E 300 North, Spanish Fork, UT 84660 - Phone 801-770-4203 (9-5 Mountain)

Copyright © 2000-2023 innoviHealth Systems®, Inc. - CPT® copyright American Medical Association