2 codes in place of 1 code

PLAIDMAN

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my doc wants to bill bunionectomy - 28292 with fusion - 28740 instead of billing 28297

he says "all the other drs are doing it " - he has 2 SEPARATE dx bunion/HAV and also OA of tars/met joint - he feels the 2 diff dx's should justify the use of 2 codes.

I was taught - coding 101 - you never use 2 codes when there is 1 code that covers the procedure being done.....
I thought I had read this in CPT (in add to training) but now I cannot seem to find it - I also cannot find any documentation that states you can unbundle procedures when you have multiple dx.

I should say that a dx of hypermobile tars/met joint will appear on the op report also.....so to me it is all being done to correct the deformity (related)

Any thoughts ? Am I being to stubborn here ? I dont like to unbundle ...

thx
Dawn
 

CodingKing

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Have you asked the doc if they would jump off a cliff if all their friends did it? I always hated the excuse of everyone else is doing it. You may want to remind the physician that while he/she will be sitting on a beach in retirement while everyone else is sitting in a jail cell ;)

From the NCCI manual:

Use of modifier 59 to indicate different procedures/surgeries does not require a different diagnosis for each HCPCS/CPT coded procedure/surgery. Additionally, different diagnoses are not
adequate criteria for use of modifier 59. The HCPCS/CPT codes remain bundled unless the procedures/surgeries are performed at different anatomic sites or separate patient encounters.

I did want to note that although there is not an NCCI edit between 28292 & 28740, its not an all inclusive list (28297 does include these 2 components). The rule listed above applies.
 

PLAIDMAN

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Have you asked the doc if they would jump off a cliff if all their friends did it? I always hated the excuse of everyone else is doing it. You may want to remind the physician that while he/she will be sitting on a beach in retirement while everyone else is sitting in a jail cell ;)

From the NCCI manual:



I did want to note that although there is not an NCCI edit between 28292 & 28740, its not an all inclusive list (28297 does include these 2 components). The rule listed above applies.

HAHA - he does not even let me finish that sentence anymore.....I am very lucky he has fantastic sense of humor

thanks for the confirmation - I think I may need to post the question right to APMA - this is the 3rd round of this particular debate we are having
 
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