Need Help!

cmort68

New
Messages
2
Location
New Berlin, WI
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0
Hello Everyone!

A patient presented to an ER with a right shoulder dislocation, ER MD was able to reduce, upon the patient being discharged (exiting the ER), the shoulder dislocated once again. My physician was consulted and he was able to reduce the shoulder. We coded 99284-57 and CPT 23650-77-RT (insurance paid). Patient presented a few days later with another dislocation, reduced by the ER MD once again. Patient then presented to our office (5 days later for follow-up) with increased pain and discomfort, x-ray confirmed a complete re-dislocation of the shoulder, she was then transferred back to an ER for further treatment by our provider. My provider then performed another reduction and we coded 23650-77-RT and we received a denial for the procedure/service was partially or fully furnished by another provider. My thought was that a modifier 78 should have been applied to the 2nd reduction by our provider, but we submitted the -77. Any help would be appreciated!
 

Deborah Marsh

Networker
Messages
31
Location
Southern Pines, NC
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Hi - 78 is specific to an operating/procedure room. Did anyone else report the code for the same DOS since the denial says another provider furnished the procedure, too, or does the payer mistakenly think it's a duplicate? One idea is to search the ortho or ED forums for a similar scenario. Best of luck!
 

cmort68

New
Messages
2
Location
New Berlin, WI
Best answers
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Hi - 78 is specific to an operating/procedure room. Did anyone else report the code for the same DOS since the denial says another provider furnished the procedure, too, or does the payer mistakenly think it's a duplicate? One idea is to search the ortho or ED forums for a similar scenario. Best of luck!
Thank you for responding! No I have not been able to confirm what the ER MD coded. And it is highly possible that insurance assumes it's a duplicate.
 
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