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Insurance Companies

  1. #1
    Location
    Long Island/New York
    Posts
    1,271
    Default Insurance Companies
    Medical Coding Books
    Anyone having trouble with insurance co's (i.e. BC/BS) bundling ortho codes that clearly should NOT be bundled?

    Example - we have had 29826 bundled with 29827 (RCR) when other co's always pay. We've also had 29877-59 bundled with 29881 when they are done in separate compartments. The main culprit lately has been BC/BS but now Oxford has been doing it as well.

    I tell the girls to call and speak to a supervisor as the rep will only state to them that it's BUNDLED. The follow-up girls don't really understand compartments to fire back at them.

    Has anyone had similar probelms? And if so, is there a better way to get it resolved outside of going up the ladder to a supervisor and appealing?

    we have over 20 ortho dr's and I'm afraid it will keep happening and will start to 'pile up'. I need to nip this in the bud!!

    Thanks for your input.

  2. #2
    Location
    Greeley, Colorado
    Posts
    2,045
    Default
    We use G0289 instead of 29877 because it is bundled into everything.
    Lisa Bledsoe, CPC, CPMA

  3. #3
    Location
    Columbia, MO
    Posts
    12,531
    Default
    Correct! 29877 is bundled and nonmodifiable. Some of the commercials in the past did pay the 29877 however many are changing this practice to coincide with the CCI edits, I am not sure why the 29827 and 29826 are not working except the CPT instuctions state to append a 51 modifier to the 29827 when performed with the 29826.

  4. Default
    BCBS does not acknowledge 29877, you have to use G0289

  5. #5
    Unhappy insurance companies lumping services
    Hi,

    I know exactly what you are talking about. I work for OB/GYN's and am having a problem with them lumping our bone density's in with our well woman exams.
    When I call on this they say it is a keying error. Seems like they are doing it a lot. I believe the term they use is redundant procedure. There seems to be no
    quick fix. If you find one please let me know I have the same concern. It seems
    contacting our provider rep is like spitting in the wind....

    thanks,
    pam

  6. Default
    I always bill G0289 instead of 29877 when billed with say a 29881. They always pay for G0289.
    Also per CPT book under 29827 it does say when 29826 performed at the same setting append mod 51. I don't see how it should bundle then, and if so I would appeal that.
    Also, when I call the ins co. sometimes I will get a different answer from say 3 different people. And when I ask to speak to a supervisor some put me on hold then hang up on me. You just got to be persistant with them. And you have to be confident in your argument against the denial.
    If they still deny then if I know I'm right I will appeal it and submit every documentation supporting my reasoning.

  7. #7
    Location
    Jacksonville, FL
    Posts
    3
    Default Insurance bundling procedures
    My ortho practice runs into the same situation when we bill exploration spinal fusion (22830) with removal of segmental instrumentation (22852). We append the 51 as instructed in the book "When instrumentation reinsertion or removal is reported in conjunction with other definitive procedures including... exploration of fusion..." append mod 51 to 22852. Some carriers pay without question, some obstinantly deny. BCBS is one we seem to appeal all the time. Some we win, some we don't depending on who the home plan is. I guess not all BC plans utilize CCI edits yet.

  8. #8
    Location
    Long Island/New York
    Posts
    1,271
    Default
    Thank you all. I have instructed the girls to change the 29877 for BC/BS to the G0289. That will help get these paid.

    Are you doing for ALL commercials? I was always under the assumption that G0289 was needed for Medicare only. Would you recommend G0289 ALWAYS when done with another code? Do you append mod 59 even thought the code descriptor has "in different compartment in same knee"?

    This helps me too. The 29826 always gets the 51 mod. So far BC/BS has been the only one to bundle the shoulder surgeries...

    Thanks!!!

  9. #9
    Location
    Long Island/New York
    Posts
    1,271
    Default
    Quote Originally Posted by smifsud View Post
    My ortho practice runs into the same situation when we bill exploration spinal fusion (22830) with removal of segmental instrumentation (22852). We append the 51 as instructed in the book "When instrumentation reinsertion or removal is reported in conjunction with other definitive procedures including... exploration of fusion..." append mod 51 to 22852. Some carriers pay without question, some obstinantly deny. BCBS is one we seem to appeal all the time. Some we win, some we don't depending on who the home plan is. I guess not all BC plans utilize CCI edits yet.
    me too...I didn't want to add it to my thread...but the knees & shoulders were my main concern. I feel the knee problems are now fixed and hope the shoulder issues come to a stop when we spk to a supervisor at BC/BS. We do a decent amount of spinal surgeries where I have your problem. I tell the girls to keep going up the ladder until it gets paid. I also send the CPT/AMA info with the appeal. Still a pain though.....

    Thanks again!

  10. #10
    Location
    Charm City - Baltimore
    Posts
    103
    Default
    I also code a for a large ortho practice and I still use the 29877 because I was also under the belief that the G code was applicable to Medicare and our WC cases. I still get paid for the 29877 and on the HCFA (lol... CMS 1500) form I type out the compartments that were worked on. We do have to appeal some with various commercial carriers, but while CCI edits say no to 29877 I am sure you have all heard a commerical carrier say they don't follow Medicare. So I take that approach when they try to deny. I would say 85% of my claims are still getting paid through appeals. I prefer not calling payors but rather writing letters because as you said, most times the person you are talking to has no idea. Good luck!
    Crystal, CPC, CCS-P

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