Wiki 27130 with 12035 and 73530

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SonoranCoder

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Why would Medicare (Palmetto GBA), pay ONLY the layer closure (12035) and then state it's PART of the PRIMARY procedure?

Any help is greatly appreicated. I've researched this one to DEATH... LOL :confused:

Thank you! :D
 
Hard to tell without reading the op note and seeing the denial. But, my take on it, the only code that should even have been billed is 27130. 73530 is bundled with 27130 so should not have been billed. Unless there was a separate wound repaired 12035 should not have been billed either, if you open up the patient, you have to close them unless there is a reason to keep the operative wound open.

Like I said without the op note this can't really be answered, but based on what you have posted this is my opinion.
 
Thank you! I appreciate your help. After MUCH research I am seeing that what you BOTH are saying is true, which was my original thought HOWEVER when you have an ortho surgeon telling you what is SHOULD be, you tend to second guess yourself... :( However, I will review the op notes again to be sure... thank you BOTH sooo much!! :)
 
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