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ED visit and hand surgery

  1. #1
    Location
    Daytona Beach
    Posts
    40
    Default ED visit and hand surgery
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    I sent a claiml into Medicare that was denied. Patient was seen in ED as a consult and hand surgery was performed.

    99255
    26615x2
    26410x2 51
    Dx code: 815.19

    Please help me with this claim. What was coded wrong? Thanks in advance!


    Heather D Unklesbay, CPC, MA
    Office Manager
    Heather D Sanders, NRCMA, CPC
    Office Manager

  2. #2
    Default
    Look at the ED services E/M codes. 99282. Why were you using a comprehensive history and exam for a problem focus? What was involved in the hand surgery? Was only two bones done? I don't think 26140 is right because it is for interphalangeal joint and the diagnosis code is for metacarpals. So wouldn't you use 26130 or 26135? Sorry can't really help without further info.

  3. Default
    Quote Originally Posted by heathergirl View Post
    I sent a claiml into Medicare that was denied. Patient was seen in ED as a consult and hand surgery was performed.

    99255
    26615x2
    26410x2 51
    Dx code: 815.19

    Please help me with this claim. What was coded wrong? Thanks in advance!


    Heather D Unklesbay, CPC, MA
    Office Manager

    Did you bill 99255 and ER as your place of service? - 9925X are Inpatient consult codes, and when used- your place of service should indicate Inpatient/ Inhouse. You should also be using a 57 modifier to the applicable E&M / Consult code.
    re: 26615 and 26410, you should use your identifying modifiers (eg: FA-F9) and 59 on the duplicate of each. Also, 26410 is not payable with just the open fx diagnosis sometimes... indicate an open wound code, or crushing injury if applicable.

    Since I do not have the reports in front of me I am not sure what E&M is applicable - using your original E&M - your claim would look like this:
    99255 -57
    26615 -F_
    26615 -F_, 59
    26410 -59, F_
    26410 -59, F_

    Can't think of any other reason why MCR would deny... if this isn't it, let us know the exact denial reason, I'd be happy to help! Have a good day!

  4. #4
    Location
    ENGLEWOOD/DENVER
    Posts
    2,338
    Default
    in addition to the above entries, often times the ER doc will charge the ER code. Most carriers will not allow two docs to bill the ER code so you may have to use an outpatient consult code (9924X).

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