Wiki ACL REPAIR OF RIGHT KNEE; GRAFT FROM LEFT KNEE

[cwilson3333]

Patient had a right knee ACL Repair [29888]

Graft was taken from the Left Knee, for which I billed 20924, using a modifier 59 on the claim

This procedure was denied per CCI Edit, stating I cannot override the edit
Even though this was a separate procedure, separate structure, am I able to appeal or is this final?

Thanks Orthos

 

[Orthocoderpgu]

I understand your frustration for sure. When you look at these two codes through the edits it shows that a modifier is not allowed. Usually grafts taken from a separate area is billable but not in this case. Since the code 20924 includes "from a distance" in the description and it hits an edit I think your chances of appealing this is very low.

 

[cwilson3333]

I understand your frustration for sure. When you look at these two codes through the edits it shows that a modifier is not allowed. Usually grafts taken from a separate area is billable but not in this case. Since the code 20924 includes "from a distance" in the description and it hits an edit I think your chances of appealing this is very low.

Thought it was worth asking. Thank you for your prompt reply