Wiki 64718 and 24359

[RebeccaMoney]

Can anyone tell me if there is any circumstance when these two can be billed together other than separate elbows? I was told that you could bill together and append modifier 59 to 64718 but I don't have my documentation anymore to justify that.
Can anyone help? Thank you

 

[Orthocoderpgu]

I'm not sure what your referring to. I would apply the same coding rules with 64718 and 24359 as any other two codes that hits an edit. As your aware using a -59 modifier is never automatic, the codes have to qualify for the -59 modifier.

 

[amyjph]

Coding guidelines, rules, and NCCI edits (if the payer follows them) would apply. There is no 100% answer or blanket answer to whether or not X code and X code are allowed together unless there is a specific guideline from the payer, manual, NCCI, CPT book, etc. that they cannot. Such as a separate procedure or inclusive procedure. It is going to depend on the documentation as well.

I would suggest checking the NCCI edits for these two procedures first (if the payer follows NCCI). Once you check that, you should have your answer. Check the NCCI manual for the definitions of what the edit reasons are.

https://www.cms.gov/medicare/coding-billing/ncci-medicare

Medicare NCCI Policy Manual | CMS

www.cms.gov

As I have also suggest to you in the past, if you are exclusively coding orthopedics, I would highly recommend getting (or asking your employer to provide) the AAOS Complete Global Service Data books for 2024. https://www.aaos.org/education/about-aaos-products/coding-resources/
Depending on the practice where you work, they could also look into CodeX.