Wiki Billing two CPT codes not bundled

[moc12]

Surgeon billed 58720 with 44160-59. Claim rejected. Per NCCI PTP edits these codes are not listed together and per EHR code check there are no bundling issues with these codes.
Should these codes have been billed as 44160 and 58720-51-RT instead?

 

[Davieda Skobel]

Here are just a few things I would check on your rejected claim,
this is just my opinion and certainly may not be what you are looking for but,
1. check that it was a female patient.
2. Are the procedure codes in fact what the surgeon performed. Read the OP report.
3.Which procedure was your primary procedure? I would guess the 44160.

If the surgeon did a 44160 and a 58720 then I would assume the 44160 was the primary so I would bill
44160
58720-59
Your insurance company that you are billing can also make a difference so you might want to check their rules.

It's always a mystery with these insurance companies! Just when you think you have it all under control they change the rules!

Good Luck, I hope this helps.
Davieda Skobel CLPN,CPC
Ohio

 

[moc12]

Thank you Davieda. I checked the CPT guidelines and the 58720 has a "separate procedure" designation and under NCCI gudelines may be reported be with another procedure if anatomically unrelated.
I would agree with you on the modifier 59 appended to the 58720. I verified on the op-report that these procedures were performed on a female patient.

 

[Rajinder_Dhammi]

In my opinion, you should bill it like this:

44160 and 58720-51-RT

You cannot append modifier 59 with 58720 as there is no CCI conflict between these two codes. Just make sure you are using correct ICDs (according to medical necessity) to these CPTs.

Thank you