Wiki Please help on surgery codes

[colleensso]

I have a question? If I am billing out a surgery in NY state does the CPT codes get paid according to RVU factor or what that insurance company finds to be there primary code? I thought in NY it is the RVU? I would love some help on this. Because I am billing surgeries according to RVU and major commercial insurance companies are changing my codes around. What should I do?
My septo codes are as follows
30520
31276 50
30140 50
31255 50
31267 50
61795
The insurance company is taking the 31276 as primary code. Why?

thanks Colleen

 

[jackjones62]

Because the RVU for 31276 is doubled when you add modifier 50 and therefore greater than the RVU for 30520.

Jennifer
ENT CT