Wiki Modifier help

[generic808]

So, we got paid on the 64835 but not the other 2 codes due to missing modifiers? Any idea as to why? The 2 procedures are components of 64835 and a -51 was added but that's not good enough?


64721,LT,51 - OPEN CARPAL TUNNEL RELEASE, LEFT, MULTIPLE PROCEDURES
64835 - EACH ADD NERVE REPAIR
12044,51 - REPAIR INTERMEDIATE- 7.6CM TO 12.5CM, MULTIPLE PROCEDURES


Procedure code 64721 is a component of procedure code 64835 (64835,51). A modifier is allowed on procedure code 64721 to differentiate between the services provided. If a modifier is already present, an additional modifier may be needed. To help you resolve this issue, the relevant CCI guidelines are available for your review. A list of possible modifiers usable with component procedure code 64721 and whether they can be used to override this CCI guideline is also available.
Procedure code 12044 (12044,51) is a component of procedure code 64721. A modifier is allowed on procedure code 12044,51 to differentiate between the services provided. If a modifier is already present, an additional modifier may be needed. To help you resolve this issue, the relevant CCI guidelines are available for your review. A list of possible modifiers usable with component procedure code 12044,51 and whether they can be used to override this CCI guideline is also available.
Procedure code 12044 (12044,51) is a component of procedure code 64835 (64835,51). A modifier is allowed on procedure code 12044,51 to differentiate between the services provided. If a modifier is already present, an additional modifier may be needed. To help you resolve this issue, the relevant CCI guidelines are available for your review. A list of possible modifiers usable with component procedure code 12044,51 and whether they can be used to override this CCI guideline is also available.

 

[cgaston]

In general, if services are being denied as components of another procedure they should not be billed separately even with modifiers.

The NCCI edits have determined these services are an inherent part of the "main" procedure so billing them separately would be considered unbundling.

 

[CodingKing]

According to AAOS Global services data, neuroplasty for surgical exposure is bundled into the primary procedure.

Also per NCCI the repair is also bundled into the procedure. Its only separately reimbursable if its the sole service or billed with one of the integumentary CPT's that only include simple repair.

 

[generic808]

Thank you both for the response, it's very helpful.