Wiki Coding 64831 and 35761 together. Help.

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stevejo

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Please help. One of the surgeons in my practice insist that 64831, repair of digital nerve can be billed and reimbursed along with code 35761, excision, exploration, repair of other vessels (digital artery) through the same incision. I have shown him documentation that these procedures are bundled under CCI edits, but it has been no help.

Can anyone direct me to site -preferably an orthopedic site- that can support my case?

Any help is appreciated.
 
Hello,
The only thing I found is that in the CPT book it says for 35761, (Not followed by surgical repair) so that code is for exploration only. He would only be able to bill for one or the other.
Hope that helps.
 
Yes, you are right, Daisyann. However, the Doc is only exploring the artery. My job is to convience him that we can only bill for one.

Since he also charges for the operating microscope (which is bundled in the artery exploration) I am trying to convience him that he would have better reimbursement to drop the artery exploration (which is bundled with the nerve.)
 
If he is only exploring the artery then he can NOT bill for the repair.
And if he is repairing or doing any other surgical procedure then he can NOT bill for exploration.
I'm not sure why he is not getting it...lol. Sorry.
 
I don't understand either, Daisyann. I am a new coder and new to the practice, so I think that may have something to do with it.

Does anyone know if any of the orthopedic associations are able to answer a coding question? The Doc suggested I call the "Hand Association". I think he will only believe it if he hears it from an official ortho "association".
 
This is the phone number to the American Academy of Orthopaedic Surgeons(AAOS):847.823.7186.
I've called before and ask to be connected with someone who can answer a coding question.
I'm sure it is because your new because I know when I first started Dr's find it hard to trust your word. Once you are there a while and prove your worth they might be more accepting to your word. I used to work for 45 surgeons, 6 different specialties, that was my first real coding job about 3 years ago, now I've been working for 1 Orthopaedic Dr for about 5 months now and it's sooo much easier. But again, I had to prove that I know what I'm talking about, also, if your young they find it hard to trust you.
Good Luck.
Daisy ;)
 
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