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Please help on surgery codes

  1. Default Please help on surgery codes
    Medical Coding Books
    I have a question? If I am billing out a surgery in NY state does the CPT codes get paid according to RVU factor or what that insurance company finds to be there primary code? I thought in NY it is the RVU? I would love some help on this. Because I am billing surgeries according to RVU and major commercial insurance companies are changing my codes around. What should I do?
    My septo codes are as follows
    30520
    31276 50
    30140 50
    31255 50
    31267 50
    61795
    The insurance company is taking the 31276 as primary code. Why?

    thanks Colleen

  2. Default
    Because the RVU for 31276 is doubled when you add modifier 50 and therefore greater than the RVU for 30520.

    Jennifer
    ENT CT

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