tobeornottobeacoder
Networker
I have a patient that has an (AAA) and was billed with 35103 which is a direct repair of aneurysm and a Gore-tex bifurcated graft was used. The description of 35103 says that this repair is with or without the graft. Well a graft was used and the payor is not paying for the graft. According to my CCI edits this graft if payable, but payor is stating it is bundled with 35103. The graft was also billed with mod 59. I want to appeal, but I cant see or find anything that states a graft is included with the repair. Can anyone shed some light on this? Any suggestions on what I should do or where I can look.
Thanks so much.
Thanks so much.