Taylor Posted Wed 04th of March, 2015 18:40:09 PM
We billed the following codes together for a surgery:
The 29825 paid, but 29823 was denied for being bundled with 29825. Will this always hold? What about with a -59 modifier on 29825? It was denied both with and without the modifier.
The 23440 is being denied for not being documented well enough in the surgery report. The following excerpt was taken from the surgery report and even highlighted in our appeals, yet was still denied: "The biceps tendon was evaluated. There was a high grade biceps tendon tear. I probed this and determined that the best thing for this patient would be a biceps tenotomy. I performed that with basket forceps. I debrided the stump of the becips." Is this really not enough documentation?
Lastly, the 20610 was denied for being bundled even though we have a -59 modifier on it.
Please let me know if these denials are valid, and how we could appeal them. Thank you so much!
SuperCoder Answered Thu 05th of March, 2015 06:13:13 AM
Thank you for the query.
CPT 20610 is included always as it is usually administered for the post operative pain management which is the part of the surgery and is never reimbursed with the other surgery codes.
CPT 23440 is for open procedure whereas the arthroscopic procedure is being performed. In addition, the surgeon is performing the biceps tenotomy which is considered a part of the debridement service billed with CPT 29823.
Finally, CPT 29825 is considered included in CPT 29823 and not vice versa and yes CPT 29825 will always be included in CPT 29823 if both the procedures are performed.
Hope it helps you.