Wiki bilateral 26055??

[Lisa Heikes]

Dr. performed 26055 FA (left thumb) and 26055 F7 (R long finger) and 25000 LT I have an insurance company rolling 26055 together and paying them as bilateral. I don't think that is correct any ideas on how to appeal?

 

[mbort]

technically it is bilateral. They are still subject to multiple procedure discounts so I'm not sure what you would be appealing???

 

[mitchellde]

I am not sure why you are referring to this as bilateral. Fingers are never bilateral, they are either FA-F9 or you use a 59 modifier. When you say they are paying them bilateral do you mean they are discounting the second one? If so that is appropriate it is not paying as bilateral. Please clarify for me.

 

[Lisa Heikes]

Beech street is rolling 26055 to one line allowing 150% then paying at 50% due to multiple surgeries.

 

[mitchellde]

I see, that is an issue, try this try a corrected claim using the 26055 and then 26055 59 and your 25000 LT. Reson is, the FA-F9 modifiers are technicall hospital outpatient and ASC modifiers and only recently are accepted for physician use, this may be a payer that does not have them in their edits for physician adjudication. Which ever has the highest RVU goes first and I do not have access to that but you should.

 

[mbort]

I am not sure why you are referring to this as bilateral. Fingers are never bilateral, they are either FA-F9 or you use a 59 modifier. When you say they are paying them bilateral do you mean they are discounting the second one? If so that is appropriate it is not paying as bilateral. Please clarify for me.

perhaps I should re-word that...26055 can be billed using either RT/LT or with the F modifiers depending on where the incision for the release is made...it can not be billed with a 50 modifier.

When I said "technically" speaking, I was referring to this being a RT/LT case.