Wiki 25447 with Tendon Transfers

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Valerie813

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Chicopee, Mass
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We are getting denials from 4 insurance carriers when we bill out either 25447/26480 or 25447/25310. They are paying the CMC arthroplasties but denying the tendon transfers. Is anyone else out there experiencing the same problem? We have appealed with evidence that these code pairs are not bundled or inclusive and should be reimbursed. Again, only 4 insurance co's denying who use the same claim scrubber vendor...wondering if that is the issue... Help!
 
Valerie813 said:
We are getting denials from 4 insurance carriers when we bill out either 25447/26480 or 25447/25310. They are paying the CMC arthroplasties but denying the tendon transfers. Is anyone else out there experiencing the same problem? We have appealed with evidence that these code pairs are not bundled or inclusive and should be reimbursed. Again, only 4 insurance co's denying who use the same claim scrubber vendor...wondering if that is the issue... Help!
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my description of 25447 states "surrounding tendons may be split or cut....tendon or fascia is inserted in place of excised bone" I read this as local tendon work is typical part of procedure.

you may have better luck using 20924..IF tendon is taken from distant site....leg,ankle

hope that helps??
 
Valerie813 said:
We are getting denials from 4 insurance carriers when we bill out either 25447/26480 or 25447/25310. They are paying the CMC arthroplasties but denying the tendon transfers. Is anyone else out there experiencing the same problem? We have appealed with evidence that these code pairs are not bundled or inclusive and should be reimbursed. Again, only 4 insurance co's denying who use the same claim scrubber vendor...wondering if that is the issue... Help!
Click to expand...



I have also been experiencing the same issue but only with BCBS. On BCBS clear claim connect, I had found that they will not except 25310 but will except 26480. I am yet to get either of the codes paid.
 
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