Wiki 27134 & 27165

[hlmcintyre]

We sent a claim to Medicare on a patient who had a revision of a total hip replacement. The physician revised both the femoral and acetabular components with a subtrochanteric femoral osteotomy and allograft bone grafting.

We billed 27134 with 27165-51 - we didn't think 59 would be appropriate since there was not a separate incision and the procedures were done in the same area. Medicare paid the 27134 but not the 27165-51 - the code on the denial is CO-B15 with a remark code of M80.

The GSD lists 27165 in the "not included" section under 27134. We feel this can be appealed but aren't sure if just sending the OP report will suffice.

Any input, as always, is greatly appreciated.

 

[malery]

Unfortunately, Medicare follows CCI Version 15.3 which does include 27165 as inclusive.

I suggest appealing to Medicare with your GSD information showing them that a board of Orthopedic peers indicate that it should NOT be inclusive and you may be succesfull. I have appealed and received payment.

Melodie Alery, COSC