Wiki Insurance denial on surgery

[melissatrue]

Hoping to receive some help..I am new at podiatry coding and trying to learn what will and will not pay..The podiatrist here at our office did a 28292 and a 28740..I appended a 51 modifier on 28740..the insurance has came back and denied the 28292 stating it and cpt 28740 are not payable on the same day..I have called and they are telling me they will not pay for both codes on same day of service..does this sound correct? Am I missing something? Any help would be appreciated..thanks

Melissa T

 

[Orthocoderpgu]

I would find out why he's performing 28740. If it's part of the bunion repair, I could see the insurance denying this as an integral part of the bunion even though it does not hit an edit. Code 28740 would need to have its own diagnosis that is unrelated to the bunion surgery. However, I have not come across this situation, yet. So this is only worth 2 cents.