Ortho help with CPT 25609- done bilateral

Idahohappy

Contributor
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Our patient fell and broke both wrists. She underwent CPT 25609 on the right and left. She has a Medicare Advantage plan and it has been IMPOSSIBLE to get this paid. We first billed:
25609-LT
25609-RT

and they did not like that. Something about too many units. Like, seriously, you cannot have 2 of these procedures done if you break BOTH hands. Next we tried:
25609-50

still same thing, did not like it. I think we tried about 4 different combinations and they are telling us there is a problem with the MUE. Does anyone have any ideas on what we are doing wrong. I have researched everything. I called them and they said it was okay to use the LT and RT but obviously they had no idea what they were doing. She also stated that they knew there was an issue but no one had ever fixed it and to try and bill again but we are not getting anywhere. Help!
 

mitchellde

True Blue
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Columbia, MO
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The only thing I see is that you have linked S52.532A to the 25609 and that is a mis match. You have linked an extra articlular fracture to an intra articlular repair. Could this be the issue?
 

Idahohappy

Contributor
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Colles fracture

I have the fracture as a Colles which can be intra-or extra-articular so I do not think that is it. Very perplexing why you can't have a left and right wrist fracture with repairs.
 
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