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MEDICARE NOT PAYING rotator cuff + other code

  1. #1
    Default MEDICARE NOT PAYING rotator cuff + other code
    Medical Coding Books
    Can anyone tell me if 23130 (ACROMIOPLASTY) is bundled into 23412 (REPAIR OF RUPTURED ROTATOR CUFF - CHRONIC) I was under the impression that they are payable separately. But medicare is b-15 denial on the acromioplasty. They did pay for the claviclectomy - 23120.

    Can someone please give me thier opinion.

    Thank you

  2. Default
    not sure what the b-15 denial is but maybe it's for the medical necessity ICD-9 code? Check to see what ICD-9 code(s) were used and maybe something is missing there?

    Good luck!
    Susan, CPC-H

  3. Default
    should have been billed 23412 and 23130/59. Medicare is separating my claims and processing them out of order. I can prove that two charges were sent together and received by medicare on the same day however they will tell me they came in two or three days apart. Call Medicare see the dates they received the claims and if they were together or separate. I'll bet they got 23130 first and processed it as the primary code. The higher RVU's are on 23412 so it should have paid as such. 23130 is inclusive to 23412 however you can add 59.

  4. #4
    The CCI edits do allow you to attach a modifier to 23130, just make sure the mod. 59 requirements apply.

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