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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!

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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".

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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.

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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.

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