Wiki 54322 with 14040 mutually exclusive

[cblong11]

I am having issues getting 14040 to pay with a hypospadias repair (54322). My provider is saying that they should not be mutually exclusive because the skin transfer is being used to cover the sutures on the shaft not for the urethroplasty and the medical records clearly state that. I added a 59 modifier to 14040 and after medicaid reviewed the medical records they still deny it. I cannot find a CCI edit that states they are included. Can anyone explain why these may be denying our another code i could use instead of 14040?

 

[rykin7609]

I am just getting into the Hypospadias procedures but one thing for sure according to the AUA the 14040 (Byers Flap) should be billable (from the American Urology Association Policy & Advocacy Brief, March 4, 2015, Guest author David Ewalt, MD., Pediatric Hypospadias Repair Workgroup chair and member of the AUA Coding and Reimbursement Committee). http://www.auanet.org/advocacy/pab/view.cfm?i=4718&a=12406

Hopefully this link will work for you. The article was sent to me in PDF format, the link was at the bottom.

Now with all that being said, your insurance company may or may not pay for it. I know that we don't in most cases but we bill it just the same when appropriate. And my trainer did say that the flap had to be specifically stated as a Byers Flap. This is substantiated in the article.

Hope this helps
Allana