Hysterectomy claim rejection

mcoria

Contributor
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Total Hysterectomy, bilateral salpingectomy, McCall's culdoplasty, posterior wall repair and cystoscopy - I'm biling CPT 58263, 57250 59 and 52000 59.
My claim was rejected for payment. The payor is indicating 57250 59 is included with 58263. The report clearly indicates posterior vaginal wall repair and perineorraphy. separate incision. who's wrong? biller or the payor.

Thank you! :confused:
 

JEYCPC

Expert
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Frederick, MD
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52000 is often included in other procedures. In this case it is bundled with both 57250 and 58263.

I think the reasoning for the rejection of 57250 is that the surgeon is already in the same area when preforming 57250. (58263 includes 57250) Did you already appeal it in writing with the op notes?
 

tracylc10

Guru
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Location
New Braunfels, TX
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Per Medicare Correct Coding Guide, you cannot code 57250 with 58263. It is a misuse of column 2 with column 1. 52000 is included in both 58263 and 57250, so you cannot code this separately.
 
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