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HELP!!! New to ortho

  1. Default HELP!!! New to ortho
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    My Dr billed a 27137 (total hip arthoplasty) and a 27041 (soft tissue biopsy). 27041 denied for "Procedure code incidental to primary procedure". Should I have used a 51 mod on the biopsy?

  2. #2
    Salt Lake North
    Default Biopsy is included with the hip procedure
    Basically a biopsy would not be reported unless it was the only procedure done.

    Any time a major procedure is performed biopsies are included with the restorative procedure, that and synovectomies as well.

    If you go to the NCCI edits and pull up the surgical policy manuals, go to chapter 1 General Policies manual. On page 14 at the bottom it specifically states that if a biopsy is performed during a major procedure, and the results of that biopsy is not going to be known until the procedure is over, the biopsy is not reportable.

    If your new to ortho you will need to read the policies for 2000 codes section as well which is chapter 4.

  3. Default
    Thank you so much! I will definitely read that material.

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