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IABallou

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I was told by an insurance company that they use Encoder Pro for their claims edits when adjudicating claims. They are stating that 27705 is a component of 27724 and as such, they will not pay that code. The surgery was done 4-2-09 and I have looked at the NCCI information for the second quarter of 2009 and these two codes are NOT bundled together based on the NCCI information from our coding software (Codeitrightonline.com).

DOES ANYONE OUT THERE HAVE ENCODERPRO AND COULD THEY CHECK THE SECOND QUARTER OF 2009 TO SEE IF IT SHOWS 27705 AS A COMPONENT OF 27724?

Thanks in advance for your imput and help.
 
I ran this info, of course no dx was given so that is coming up as an error, but otherwise I just get the following:

Modifier -51 Required -Procedure code 27705 has been billed on the same DOS as another procedure without an appropriate modifier. Typically, procedures or services with the lower relative value should be reported with modifier 51.

I ran this with Blue Cross and Blue Shield of Arkansas and Trailblazer, since those are the Medicare carriers that came up for Oklahoma. It is the same as what I get for WPSMedicare for here in Michigan. I also ran it with the commercial edits option and got the same thing.

You can get a free 30 day trial of encoder thru their website as well.

Hope this is helpful,

Laura, CPC, CEMC
 
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