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Lydia Posted 7 Year(s) ago

patient had a r. inguinal hernia repair and a recurrent left inguinal hernia repair at the same time. I coded:
49520Lt dx 550.91
49505RT dx 550.90

I have been denied by Medicare for 49505 as "not paid separately"
CO-B15. CAN SOMEONE GIVE ME SOME ADVISE....THANKS!

SuperCoder Posted 7 Year(s) ago

There are cases when wrong billing would cause loss of revenue, and to get back the lost revenue is difficult. This is an example. CPT 49505 and 49520 are mutually exclusive, since 49520 is column 2 code here, we should have billed: 49505-RT, 49520-59,LT

Now, we have already billed and got paid for 49520 without modifier 59. So, it is impossible to reverse the process in a normal manner. Now, if you are going to rebill 49505 with modifier 59 and RT, then it is a wrong practice.

Posted by Lydia, 7 Year(s). There are 2 posts. The latest reply is from SuperCoder.

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