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Wiki Pediatric Neurosurgery Coding Question

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Rosabell

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Hi I was wondering if someone could help with a claim denial for coding. My physician performed a Right & Left frontal Parietal xpansile Craniotomy (61322) 50 modifier and also did a Barrel Stave Osteotomy of frontal bones (61340) insurance only paid the 61322 procedure and bundled the osteotomy to the crainotomy. I can't find where those two codes are bundled. Please let me know if this is indeed a bundled code.
 
No 50 modifier

NOT my area of expertise, but this is what I came up with ...

First ... 61322 does NOT take a 50 modifier

Second, if your documentation shows the surgeon was working on a completely different area of the skull, you should be able to appeal with op report. I don't find an edit, either, but the descriptions seem to involve the same area of skull, so that may be the issue with the insurance company.

Hope that helps.

F Tessa Bartels, CPC, CEMC
 
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