Sdrivera
Contributor
DOS 12/12/2023. My provider is billing 64704 with 25000. Payer is BCBS TX. 64704 is being denied due to it being included with 25000. Is there anyway to get this paid or will this always be denied? There are no NCCI edits disallowing the codes to be billed together. When I ran the codes through BCBS's C3 edit, the edit comes back indicating that 64704 is included in 25000 per the Global Service Data by the AAOS and that CPT considers the neuroplasty part of the essential treatment.
Claim went out like this:
29848-LT (I'm not worried about this procedure since it was paid)
25000-LT-59
64704-LT-59
Only concerned about the 25000 and 64704. The provider bills these out together frequently and the 64704 gets denied.
Note from op report:
Attention was paid to the dorsal radial aspect of the wrist. A 1-cm incision was marked out with a surgical marker and the skin was subsequently incised with a #15 blade just distal to the radial styloid in a transverse fashion. Hemostasis was achieved with bipolar electrocautery. Blunt dissection was carried down through the subcutaneous tissues. A significantly thickened first dorsal compartment was identified. A tenovaginotomy was made with a #15 blade and the sheath was decompressed proximally into the forearm and distally to the insertion site of the abductor pollicis longus. An accessory compartment was identified, which encased the extensor pollicis brevis, which was subsequently decompressed. The wrist was taken through its full range of motion. There was no subluxation of the tendons as it traversed through flexion and extension. The radial nerve was identified coursing over the extensor compartment, which required neurolysis as there was a significant amount of adhesions encasing the nerve. This was done under loupe magnification.
The patient also had a surgery performed on 10/17/2023, but I don't believe they're bundling the 64704 into any of those codes because it was performed on the contralateral side and the other codes should have also denied if that were the case.
Any help is appreciated! Thank you!
Claim went out like this:
29848-LT (I'm not worried about this procedure since it was paid)
25000-LT-59
64704-LT-59
Only concerned about the 25000 and 64704. The provider bills these out together frequently and the 64704 gets denied.
Note from op report:
Attention was paid to the dorsal radial aspect of the wrist. A 1-cm incision was marked out with a surgical marker and the skin was subsequently incised with a #15 blade just distal to the radial styloid in a transverse fashion. Hemostasis was achieved with bipolar electrocautery. Blunt dissection was carried down through the subcutaneous tissues. A significantly thickened first dorsal compartment was identified. A tenovaginotomy was made with a #15 blade and the sheath was decompressed proximally into the forearm and distally to the insertion site of the abductor pollicis longus. An accessory compartment was identified, which encased the extensor pollicis brevis, which was subsequently decompressed. The wrist was taken through its full range of motion. There was no subluxation of the tendons as it traversed through flexion and extension. The radial nerve was identified coursing over the extensor compartment, which required neurolysis as there was a significant amount of adhesions encasing the nerve. This was done under loupe magnification.
The patient also had a surgery performed on 10/17/2023, but I don't believe they're bundling the 64704 into any of those codes because it was performed on the contralateral side and the other codes should have also denied if that were the case.
Any help is appreciated! Thank you!