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'29540' rejection

Boris Posted Tue 08th of October, 2013 17:23:23 PM

Patient had bilateral 276.70 and 726.79,
Patient had bilateral '20550' and also had bilateral '29540'

'29540' LT 59
'29540' RT 59

We are getting rejections for these procedures with remark codes:

CO-151 : Payment adjusted because the payer deems the information submitted does not support this many/frequency of services.

N362 : The number of Days or Units of Service exceeds our acceptable maximum

As soon as we put bilateral, both codes are rejected.

SuperCoder Answered Wed 09th of October, 2013 12:34:54 PM

If your orthopedist performs the strapping in coordination with fracture care, injury, or dislocation treatment, you're not going to be able to separately report 29540 (Strapping; ankle and/or foot).

Reason: CPT guidelines state that you can separately report 29540 "when the cast application or strapping is an initial service performed without a restorative treatment or procedure(s) to stabilize or protect a fracture, injury, or dislocation and/or to afford comfort to a patient." Unfortunately, payers have yet to form a consensus on interpretation of this guideline.

For example, your orthopedist performs a cortisone injection for plantar fasciitis (20550, Injection[s]; single tendon sheath, or ligament, aponeurosis [e.g., plantar "fascia"]) and then uses strapping to further alleviate pain. You may be able to collect for both procedures since a cortisone injection is not really "restoring" the plantar fascia, and because the injection and the strapping provide different therapeutic effects.

Watch out for bundling: In this case, you would list 20550 in line 1 of #24D of the claim form and then list 29540 with modifier 59 (Distinct procedural service) appended on line 2 of #24D.

Because National Correct Coding Initiative edits make 29540 a component part of 20550, modifier 59 lets your payer know that these are distinct services. You should link both procedure codes to the same diagnosis code, 728.71 (Plantar fascial fibromatosis).

If the surgeon does not perform the strapping in conjunction with a "restorative treatment," you should have a fighting shot at reimbursement, but your payer may disagree on your definition of restoration. Unless your payer has a specific written guideline that bans the dual reporting of the specific nonrestorative procedure and strapping, you may opt to move forward with an appeal.

Boris Posted Mon 21st of October, 2013 17:04:57 PM

Unfortunately the question was misunderstood. We are trying to get reimbursement for bilateral codes:
'29540' LT
'29540' RT These two codes are performed on the same day, on different sites.

We are getting these rejection codes for these two lines from payer (Medicare):

CO-151 : Payment adjusted because the payer deems the information submitted does not support this many/frequency of services.

N362 : The number of Days or Units of Service exceeds our acceptable maximum

M80 : Not covered when performed during the same session/date as a previously processed service for the patient

CO-B15 : This service/procedure requires that a qualifying service/procedure be received and covered. The qualifying other service/procedure has not been received/adjudicated. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.

How can we bill these to get reimbursed?

SuperCoder Answered Tue 22nd of October, 2013 17:39:53 PM

In what state are you located? Some Medicare carriers have an LCD that applies to code 29540.

Thanks,

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