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    Coventry and 20611 denials

    Has anyone else had issues with Coventry lately denying 20611 as not medically necessary per LCD? The only LCD I can find is for injections of the knee with hyaluronan. However, the ones that are denying are not being injected with hyaluronan and may be in any of the major joints, not just...
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    PT/OT units

    Our physical and occupational therapists do their own coding, but I review denials. Most of the information I can find limits the number of units by the total time. They have been billing any services performed for at least 8 minutes. So for example they did 3 different services for 8 minutes...
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    Shoulder impingement

    I'm curious- what is the difference between shoulder impingement and shoulder impingement syndrome? They code to M25.81_ and M75.4_. I've never seen my providers call the impingement a 'syndrome'. Thoughts? Susan
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    Anterior & Posterior capsulorrhaphy

    I read an interesting AAOS article ( https://www.aaos.org/AAOSNow/2018/Mar/Managing/managing01/?utm_source=The%20Monthly%20Roundup%20March%202018&utm_campaign=Monthly%20Roundup%20-%20March%202018&utm_medium=email&ssopc=1 ) recently, and wondered about this: Code 29806 covers both anterior and...
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    PNT shoulder

    Hi! I'm not sure of the correct code for a percutaneous needle tenotomy of the shoulder. My provider is using 23405, but that is an open procedure. Is there a better code, or would you use unlisted? What would you compare it to- 23405 or 24357? Superior rotator cuff PNT- PROCEDURE NOTE: LEFT...
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    Open patellar debridement

    Hi, we billed this as 27599 compared to 27380. Insurance reviewed the record and said it wasn't supported. I haven't found a better code for the open patellar debridement; that is how the provider referred to it, although I could also see it as a tenotomy because he states he made vertical...
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    Anterior labral repair

    I've searched high and low for an answer without luck. I know the shoulder labrum/capsule is split into superior and inferior in order to bill 29807 or 29806. However, it is rarely cut and dry as to which area it is in. I often see tears that cross over and/or are not designated as SLAP tears...
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    DME bundling

    I posted this under the Modifier thread originally, but I wonder if I'd have better luck with other ortho coders: I have a few claims that were billed with DME L1902 and L4361 on the same day where BCBS and Humana denied L1902 for bundling. They were both billed with KX and a laterality...
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    Mod 59 with DME

    I have a few claims that were billed with DME L1902 and L4361 where BCBS and Humana denied L1902 for bundling. They were both billed with KX and a laterality modifier. We appealed, and Humana paid but BCBS still denied, stating per NCCI it is mutually exclusive. I have searched and searched but...
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    Non-operative treatment and ORIF on same day

    I have an odd situation- the patient was admitted to the hospital by one of my providers for a hip fracture. The patient opted for non-operative treatment and the provider planned for pain management and physical therapy. Later the same day, the patient underwent ORIF by another one of my...
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    knee OCD lesion repair

    The patient has an OCD lesion on the femoral condyle. The provider did arthroscopic debridement of it followed by open repair with screws (no grafts). The CPT description of 29885 doesn't indicate that it would be arthroscopically aided, so I don't believe I can use it to encompass the whole...
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    Bilateral procedure- one side discontinued

    I'm hoping to get an opinion on the correct coding for this. Physician performed 64483 bilaterally on one level, however, had issues and could not complete the left side. It was billed as 64483-RT, 64483-53-59-LT. Medicare paid the right side, but denied the left as information submitted does...
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    72020 and 72120

    I work for an ortho clinic and we're getting a lot of denials this year for 72020 bundling with 72120. When I put it into CodeCorrect, it doesn't bundle. Our providers often do them both for lumbar, but 72120 is for bending views and 72020 is for AP view. The only reason I can think of why some...
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    Talar cyst subchondroplasty

    I haven't seen a surgery like this before, and I'm not finding much when I search. I'm leaning towards unlisted code 27899 with 77002-26 at this point, although I'm not even sure what code to compare it to. Does anyone have experience with this? Thanks! Dx: 1. ankle extensive synovitis with...
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    Patellar component after TKA

    I have a patient that previously had a TKA with replacement of the femoral and tibial components, but not the patella. Now the patient has pain and degeneration of the patella, so my physician resurfaced the patella and added the patellar component. Nothing was done with the femoral/tibial...
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    Achilles tendon lengthening

    I'm having difficulty in choosing the right combination of codes for these procedures. I believe the haglund excision is 28120. I don't believe the Achilles debridement is separately billable. For the Achilles lengthening I'm looking at 27685 or 27687, but neither one seems an exact fit...
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    Multiple units of 20551

    Hi, my physician is billing 20551 for injection at the left and right lateral epicondyle as well as the left medial epicondyle. I see that LT, RT and 50 are not options. Would you put one unit per line with the appropriate dx and a 59 mod on the 2nd and 3rd lines, or would you put it all on one...
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