Wiki 27759 and 27535 billable together or incidental even with seperate incision?

[cliff.chen89]

Hello my fellow coders! Wanted to know if I'm able to bill CPT 27759 and 27535 together or if its considered bundled/incidental? I checked the NCCI edits and NCCI doesn't bundle these two, yet even though they were both performed on the same leg, one was done at the tibial shaft, and the other done on the proximal tibia. Can these two be coded together? And if there was a separate incision made would I need a modifier 59 even though NCCI does not bundle them?

 

[RyanRaichCPC]

Hello Cliff. Yes, these procedures can both be coded together. One is for fixation of the proximal tibia while the other is of the tibial shaft. If you have two separate fracture diagnoses that correspond to these CPT's and there are no edits, I would definitely try billing with just the laterality and the correct diagnosis tied to each CPT without modifier -59. As modifier -59 is so overused, just having two separate fractures in different parts of the tibia should suffice and capture the procedure you are coding out as distinct and separate without the use of -59. Are you coding facility or professional?

 

[cliff.chen89]

Thanks Ryan! Coding Professional to answer your question. One thing I've asked (w/ no answer yet) and still been looking for so far is another list/document similar to NCCI, separate procedure, or the CMS NCCI policy manual that I can show my Providers why some procedures are bundled/inclusive/incidental with one another, even if NCCI doesn't bundle them like:

ORIF ankle fx w/ syndesmosis 27792/27814/27822 & 27829
hemiarthroplasty w/ excision trochanteric bursa 27236 & 27062
orif wrist w/ tenotomy 25609 & 25290
intramedullary nail tibia w/ clsd fibula tx 27759 & 27780

since none of these are bundled by NCCI yet some the answers I have gotten from this forum (and the ins denials) are saying that they are incidental and that NCCI edits dont cover everything. So what else is there?