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Thread: Bialteral and multiple surgeries same claim

  1. #1
    Join Date
    Apr 2007
    South Salt Lake

    Default Bialteral and multiple surgeries same claim

    AAPC: Back to School
    When billing for a full sinus surgery we submit the claim in the following way.

    we have one insurance that is giving us grief in getting it pd. Is this the way that you would bill this out? Also, would you have listed the highest bilateral code 1st and rank them that way? Any advice would be appreciated. Thanks

  2. #2
    Join Date
    Apr 2007
    Tuscaloosa, AL


    Different carriers want claims submitted differently. For example, our Medicare carrier and Tricare want the bilateral procedures billed on one line as you have indicated; our local Medicaid wants a left line (31255-LT) and a right line (31255-RT); our local BCBS prefers 31255 and 31255-50. It is a good idea to list your highest reimburseable procedure first on your claim, but most insurance companies have software that "ranks" your lines anyway. Find out what this specific carrier requires for correct payment of your claim and bill accordingly.

    Jerri, CPC

  3. #3
    Join Date
    Apr 2007
    Albany, New York


    can't help myself..........

    seeing as BCBS wants you to bill (ie: 31255 & 31255-50 which technically indicates "3" sites), do they pay you for 3 of those procedures?? I am continually amazed at the the lack of understanding of modifiers that the people who are processing claims (carriers) have.......
    Karen Maloney, CPC
    Data Quality Specialist

  4. #4
    Join Date
    Apr 2007
    St Louis West Chapter

    Default Sinus Surgery

    Remember Sinus Surgery codes can be bundled on the certain codes review CPT book 2010 page 150. The code 31276 gives examples under the code regarding some of the other codes that were used as well. Make sure to read the denial and see exactly what the remark codes are as well as any other code the carrier is using to deny the encounter.

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