Wiki Bone Graft cannot be billed with Dental Implant Removal?

[GinaLea77]

Hi All,

We are an oral surgery practice. We billed our patient's medical plan for the services below. Blue Cross paid on the 21210 but denied the 20680 stating "Service is incidental to the primary service code. Payment is included in the allowance for the primary service. The coding practice utilized is inconsistent with the current coding protocol. You should not bill the patient for the balance resulting from your coding practice. Patient has been notified."

21210 - Bone Graft
20680 - Dental Implant Removal

According to KnowledgeSource, formerly Code Correct, the submission is valid. What am I missing?

Thank you.

 

[Orthocoderpgu]

Full disclosure, I code orthopedic surgeries, not oral procedures. In orthopedics if hardware needs to be removed before another procedure can be performed in the same area, then removing the hardware is bundled. Seems like the insurance is following this same thought process. I'm not saying they are correct, it's just the thought process. Something else to keep in mind is that insurance companies are not "forced" to follow specific guidelines. They can get their information from anywhere they want. I worked for an insurance company long ago, and they do "try" to do things correctly in their eyes. But their decisions can fluctuate depending on who they are listening to at the time.

 

[GinaLea77]

Full disclosure, I code orthopedic surgeries, not oral procedures. In orthopedics if hardware needs to be removed before another procedure can be performed in the same area, then removing the hardware is bundled. Seems like the insurance is following this same thought process. I'm not saying they are correct, it's just the thought process. Something else to keep in mind is that insurance companies are not "forced" to follow specific guidelines. They can get their information from anywhere they want. I worked for an insurance company long ago, and they do "try" to do things correctly in their eyes. But their decisions can fluctuate depending on who they are listening to at the time.

First of all, thank you for your reply!

We are not contracted with the insurance company, am I to assume we are not able to balance bill the patient for the bundled procedure?