Mulitple procedures

mentsa

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Flowood, Mississippi
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Our physicians are billing for different procedures done on the same date of service at the same time. Examples of the cpt codes used are 30115, 31288, 30140, 31267, 31255, 61782, 30520, and 31276. Does anyone have any suggestions on billing these codes together to avoid receiving front end edits from our clearing house. We are having trouble getting them to go through. Thank you.
 

csperoni

True Blue
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Selden
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Some of those codes are CCI edits. IF APPROPRIATE, you may want to consider -X__ modifiers or -59. However, if they are the same date of service at the same time, you should ensure the documentation supports all being billed together. There is a reason they are hitting front end edits.
 

GinaRS520

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Hinsdale, IL
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Our physicians are billing for different procedures done on the same date of service at the same time. Examples of the cpt codes used are 30115, 31288, 30140, 31267, 31255, 61782, 30520, and 31276. Does anyone have any suggestions on billing these codes together to avoid receiving front end edits from our clearing house. We are having trouble getting them to go through. Thank you.
I use a combo code for:
CPT 31255 and 31276 = CPT 31253 or
CPT 31255 and 31288 = CPT 31259
I bill for CPT 31253 since it has a higher RVU (higher reimbursement) of 14.4, than 31259 which has an RVU of 13.57
Hope this helps
 

GinaRS520

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Hinsdale, IL
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Can CPT 67182 be billed in the office setting? Received a denial for place of service. All other codes were paid for.
Hello
I have found that it depends on the insurance carrier. Some will cover for 61782 (InstaTrak/Medtronics) if used in an office setting when performing ESS. I would recommend checking the insurance's medical policy and guidelines on CPT 61782. Or inquire if it is a covered code with the insurance when you are calling for precert or preauth. You can also request for a predetermination from the insurance prior to surgery.

Hope this helps!
 

jackjones62

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Niantic, CT
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These are all endoscopic sinus surgery codes and not performed as an office procedure. 30115 is bundled, considered inclusive. 61782 is an add on code, no modifier, used for video guidance during surgery, it is payable. MENTSA is correct, some of the 312XX codes were bundled 2 or so years ago so you have to revisit your CPT book. There are 4 sets of sinuses, frontal, sphenoid, ethmoid and maxillary, remember, if your surgeon performs them bilaterally remember to use modifier 50 when appropriate. You also have a septoplasty, 30520, and turbinate resection, 30140. If the turbinate resection is performed bilaterally, again, remember modifier 50.

Hope this helps!

Jennifer
Coding Analyst
 

b.cobuzzi

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I do not think that a doctor would have the equipment to perform stereotactic CT guidance in the office. That very expensive equipment is usually found in an OR, (ASC OR FACILITY). Although the stereotactic guidance uses a CT as input, which may have been taken in the office (if the office has CT equipment capable to create CT disks for the OR), the office does not have what is needed to do 61782,
 

b.cobuzzi

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And be careful using the X- modifiers or 59 modifier, making sure that the modifier is supported in the documentation. If not, you have to accept the bundle and not bill for the lower RVU code. For example if you are trying to bill for 31253 and 31276 on the same side of the nose, XS or 59 does not apply, so you would just bill 31253, not 31276 because 31253 includes a frontal sinusotomy.
 
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