January 22, 2015
Hi, I have a case where I have two surgeons who did a fusion together. The codes were all billed with modifier 62. The commercial insurance denied for modifier 62 with code 22842. As I research, I realize CPT states modifier 62 is inappropriate with 22842, although I see that CMS payment policy still allows modifier 62 to be paid. As I read the report, I see that each surgeon did distinct parts – one surgeon did the right side while the other did the left pedicle screws/rod placement. Should I appeal the denial?
No, you should not appeal the denial of 22842-62. Physicians are to follow CPT coding guidelines, which do not allow appending modifier 62 to the spinal instrumentation codes. Therefore, it is not appropriate to bill in this manner or expect to be paid.