Wiki +29826 Denied as being included

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woowooz7

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+29826 is an add-on code to 29823. It has been denied by Medicare as being included with another procedure.

Patient also had 23412 (open RC repair) that same day.

29826 is an add-on code so I don't see how appending 59 modifier would be legal/correct.

Any advice is greatly appreciated. I saw this same question asked and answered on this forum in 2010 so I though I better get this answered with any "new" information.

Thanks!
 
Per notation in the CPT book you must code first (29806-29825, 29827-29828). So it would be inappropriate to bill with an open procedure. And also as stated previously CCI edits does not allow it either.
 
Joseph, 29823 was coded first but 29826 was bundled in with another procedure for same DOS. That's what didn't make sense to me. How can an add-on code be denied as "included" in with another procedure. Weird but I'm finding that several insurance companies will do or say anything to avoid paying a claim in it's entirety. :mad:
 
woowooz7 said:
Joseph, 29823 was coded first but 29826 was bundled in with another procedure for same DOS. That's what didn't make sense to me. How can an add-on code be denied as "included" in with another procedure. Weird but I'm finding that several insurance companies will do or say anything to avoid paying a claim in it's entirety. :mad:
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It is not considered an add on code to 23412

It is only considered add on to its parent scope codes.
 
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