Results 1 to 6 of 6

bilateral 26055??

  1. Default bilateral 26055??
    Exam Training Packages
    Dr. performed 26055 FA (left thumb) and 26055 F7 (R long finger) and 25000 LT I have an insurance company rolling 26055 together and paying them as bilateral. I don't think that is correct any ideas on how to appeal?

  2. #2
    Location
    ENGLEWOOD/DENVER
    Posts
    2,338
    Default
    technically it is bilateral. They are still subject to multiple procedure discounts so I'm not sure what you would be appealing???
    Mary, CPC, CANPC, COSC

  3. #3
    Location
    Columbia, MO
    Posts
    12,573
    Default
    I am not sure why you are referring to this as bilateral. Fingers are never bilateral, they are either FA-F9 or you use a 59 modifier. When you say they are paying them bilateral do you mean they are discounting the second one? If so that is appropriate it is not paying as bilateral. Please clarify for me.

    Debra A. Mitchell, MSPH, CPC-H

  4. Default
    Beech street is rolling 26055 to one line allowing 150% then paying at 50% due to multiple surgeries.

  5. #5
    Location
    Columbia, MO
    Posts
    12,573
    Default
    I see, that is an issue, try this try a corrected claim using the 26055 and then 26055 59 and your 25000 LT. Reson is, the FA-F9 modifiers are technicall hospital outpatient and ASC modifiers and only recently are accepted for physician use, this may be a payer that does not have them in their edits for physician adjudication. Which ever has the highest RVU goes first and I do not have access to that but you should.

    Debra A. Mitchell, MSPH, CPC-H

  6. #6
    Location
    ENGLEWOOD/DENVER
    Posts
    2,338
    Default
    Quote Originally Posted by mitchellde View Post
    I am not sure why you are referring to this as bilateral. Fingers are never bilateral, they are either FA-F9 or you use a 59 modifier. When you say they are paying them bilateral do you mean they are discounting the second one? If so that is appropriate it is not paying as bilateral. Please clarify for me.
    perhaps I should re-word that...26055 can be billed using either RT/LT or with the F modifiers depending on where the incision for the release is made...it can not be billed with a 50 modifier.

    When I said "technically" speaking, I was referring to this being a RT/LT case.
    Mary, CPC, CANPC, COSC

Similar Threads

  1. 26055 and 26145
    By scooter1 in forum Orthopaedics
    Replies: 0
    Last Post: 06-23-2015, 01:39 PM
  2. 26055 & 26121 or 26123???
    By sleepycats in forum Orthopaedics
    Replies: 1
    Last Post: 10-29-2010, 09:13 AM
  3. 26055,26055,26160,26160
    By ASC CODER in forum Plastic Surgery
    Replies: 2
    Last Post: 04-28-2010, 03:12 PM
  4. 26055 and 26160 am I missing anything?
    By ASC CODER in forum Medical Coding General Discussion
    Replies: 1
    Last Post: 04-28-2010, 07:19 AM
  5. 26055 and 26160 help
    By ASC CODER in forum General Surgery
    Replies: 0
    Last Post: 04-27-2010, 08:56 AM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •  
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?

Login

Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.