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Need help with surgery

  1. #1
    Default Need help with surgery
    Medical Coding Books
    I BILLED 28119 WITH LT MODIFIER
    THEN 64704 WITH A 51 IT DENIED SAYING IT WAS INCLUSIVE TO THE 28119

    THEN ON ANOTHER SURGERY I BILLED 28296 WITH LT MODIFIER THEN 28285 51 LT IT DENIED SAYING IT WAS INCLUSIVE
    DOES ANYONE KNOW WHY SHOULD I HAVE THE 59 MODIFIER INSTEAD.
    THANKS

  2. #2
    Location
    High Point, NC
    Posts
    84
    Default
    For CPT 28296 & 28285 - CPT 28285 is bundled into 28296 per CCI so you would need a 59 to unbundle it. You should also use the digit modifier for 28285 instead of LT.

    For CPT 28119 & 64704 - this could be a carrier 'black box' type edit. Some payers have their own edits in place. You should be able to appeal the decision with your documentation.
    Cindy Gallimore, CPC, CENTC

  3. #3
    Default Thank you
    I just wanted to say thank you

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