Wiki 29874 denied!

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Amzie

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I had billed out a claim for one of my doctors because as: 29876 (tricompartmental), 29881 (lateral), 29874 (patella) and the insurance company denied the 29874 stating it is bundled.

I thought that I was able to bill out for the removal of a loose body since it was in a seperate compartment?
Am I missing something? Can someone explain, I would really appreciate it very much!

Thanks in advance!!
 
AAOS states it is separately billable if done through a separate incision or if the loose body is .5mm or larger. However, remember it the insurance company always has their own policies. We normally bill it with a modifier 59 if it meets the above requirements. If so, you may want to consider appealing your claim.

Angie :)
 
I see the 29876 was performed tricompartmentally. This would eliminate the ability to use the 29874 as there isn't a compartment left untouched with a more extensive procedure.

Second, the payor may want the G0289 for billing the loose body 29874.
 
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