Wiki 29125 denied

[coders_rock!]

Pt received 20526[50] & 29125[50]

cpt 29125[50] is being denied because of modifier issue. Per cci, 29125 is bundled to 20526[50] but a modifier is allowed. It seems as if they are asking for an additional modifier for cpt 29125[50]. What modifier might this be?

Any suggestions?

 

[PLAIDMAN]

I am curious why you feel you can un bundle? Just because a modifier is allowed does not mean you can un bundle.

 

[maryanneheath]

Per the complete global service data for CPT 20526, application of splint/cast is included and therefore should not be billed separately. Many payors do not want modifier 50 but instead want RT and LT, two separate line items. I hope that helps.

 

[coders_rock!]

Per the complete global service data for CPT 20526, application of splint/cast is included and therefore should not be billed separately. Many payors do not want modifier 50 but instead want RT and LT, two separate line items. I hope that helps.

THAT WAS HELPFUL, THANK YOU!

DO YOU MIND PROVIDING ME WITH THE LINK TO WHERE YOU OBTAINED THIS INFORMATION SO I CAN HAVE IT FOR FUTRURE REFERENCE.

Have a great weekend!

 

[maryanneheath]

Hi, I don't have a link for you. Every year we get a two volume set from the AAOS called the complete global service data for orthopedic surgery. You can look up CPT codes and see what is included in the global package and what is not. We use them all the time, and they are very helpful for providing documentation for appeals as well.

as far as the RT and LT, that is just my experience. You can look on different insurance companies web sites and see what their "wants" are as far as bilateral procedures.

Have a good weekend, yourself!

 

[coders_rock!]

Also can J1100 & J3490 (unclassified drug) that has been classified as Xylocaine be billed together?