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CPT 26025 vs 26030

S

Susan Carter CPC

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29
Location
West Chazy, NY
Hello Forum

Our provider did a drainage of the palmar bursa bilateral hands. We had billed to Medicare using 26025/LT and 26025/RT and Medicare denied both for two many/frequency of services.
Should the claim be billed using 26030 X1 as it indicates multiple bursa? It is a bilateral procedure, different site/different hand.

Thank you
Sue
 
26030 is the appropriate code. I believe there are 2 palmar bursa in each hand. so 26025 for 1, 26030 for more than 1. Since the code isn't specific to one hand it would not technically be bilateral
 
26025 does have a bilateral indicator "1". Maybe they want it billed with a 50 instead of LT/RT? I have run into that a few times lately with codes that I wouldn't think should be billed as bilateral, such as injections, but do have an indicator of 1.
Just a thought.
 
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