Wiki CPT 26025 vs 26030

[Susan Carter CPC]

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

 

[CodingKing]

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

 

[solocoder]

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.