kmignault
New
A provider billed 26210-F5, 26210,-F3, 26160-59-F3, 26160-59-F5, 11730-F5.
The insurer requested medical records, then paid 26210-F5, 26210-F3 and 11730-F5. They denied 26160-59-F5 and 26160-59-F3 as not separately payable because the records received don't support that the procedure performed was distinct and therefore the modifier 59 is supported.
I am new to coding/auditing and am being asked what should have been billed. I believe it should have been: 26210-F5, 26210-F3 and 11730-F5 only because 26160 appeared to be done through the incision of 26210 and therefore is not separately reimbursable.
Does this make sense? I know it sounds confusing, if I need to provide more specific information with PHI redacted I will do so.
The insurer requested medical records, then paid 26210-F5, 26210-F3 and 11730-F5. They denied 26160-59-F5 and 26160-59-F3 as not separately payable because the records received don't support that the procedure performed was distinct and therefore the modifier 59 is supported.
I am new to coding/auditing and am being asked what should have been billed. I believe it should have been: 26210-F5, 26210-F3 and 11730-F5 only because 26160 appeared to be done through the incision of 26210 and therefore is not separately reimbursable.
Does this make sense? I know it sounds confusing, if I need to provide more specific information with PHI redacted I will do so.