Wiki 44140 & 49561

[mieka.schambach]

We billed a 49654 with mod 51 and 80 and also billed a 44602 with a modifier 80. However we keep getting this rejection from our system

"Trigger Procedure [44140] on Claim ID [], Ext/Int Line ID [697734/1] and Target Procedure [49561] on Claim ID [], Ext/Int Line ID [697735/2] are Unbundled and the Target is inappropriate. The Standard Policy Statement reads "Standards of medical / surgical practice".

I don't understand why we are getting this rejection. it at first sounded like it was denying as bundled, however we have tried billing 49654 with a mod 59 and a 51 (different times) and we keep getting this rejection. HELP!

 

[bigredcag]

Could it be that you are coding the hernia as laparoscopic and the small intestine repair as open?
or that the incisional repair is included because you had to Open the pt with the 44602 and the hernia repair is incidental to the major surgery performed.