Wiki 27917 Clsd tx pelvic ring fx

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montie99

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I am getting denials for using this in POS 11. Anyone have any insight?

Thanks,
 
We used pelvis fx. The denial stated procedure type is inconsistent with place of service.
 
We haven't billed any with POS 11 yet as we've had anterior only so far in the office, but in know I will run into this in the future. Did you use modifier 57 or 25? I think I would have coded the EM code with a 25 (to protect from zero global day procedure) and 27197 and make sure diagnosis includes posterior. I'll be following the outcome/explanation on this closely!
 
I am receiving a denial for this due to it not having a facility fee! Therefore, what it means is that even though this is a non-manipulation code, if it is performed in the office, it's not covered by MCR or MCD. Is there any other way to bill for these fractures? The physician is managing this fracture, and it does NOT require a trip to OR!
 
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