Wiki Add on code 49905 - I have billed CPT 49905 with 44660

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EricaR

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Clemmons, NC
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Hello,

I have billed CPT 49905 with 44660 and 44320, Cahaba our Medicare Contractor has denied stating the appropriate primary code was not billed with the add on code. There is no CPT guidance on what the primary has to be and I have never had problems in the past. I did find a CMS transmittal stating that is no set primary but they encourage the individual contractors to create such a policy. (which I doubt Cahaba did, if they did I can't find it.) Now I called Cahaba and of course the rep tells me there is a ONE specified CPT for primary but they can't tell me what it is. (OF COURSE!) Has anyone else had this issue??? So disturbed!

(I also posted in reimbursment, hoping for some insight!)
 
tbenz1

This is an "open" surgical procedure-add-on code that must be billed with another "open" procedure such as 49255. Since the primary procedure was only laparoscopic, then this would not apply. If the surgeon had to start a laparoscopic bypass, but then needed to convert to an open procedure (43846 with V64.41) then this could apply.
 
tbenz1,

Thanks for your response, although it kind of confused me. CPT 44320 and 44660 are both open procedure codes. And 49905 is an open add on code.

Erica
 
49905

Hello,
I too am having issues getting add-on code 49905 paid :mad:. We are billing codes 35221 and 48150 which were done during the same operative session and both are open procedures. I looked on CMS' website, and it does not list specific primary codes. In this case it is okay to bill any open procedure along with the add on. Although Medicare (Cahaba) shows that there is a specific primary code that should be billed, there is a way to bypass that edit. You can Appeal the denial with documentation or call and ask the Medicare rep to send the claim back for review because it is not a RUC and can be reopened. I am having to Appeal with documentation! I hope this helps someone else. :D
 
Hello,

I had teh same issue and I appealed and Medicare denied the redetermination. Then I sent in a second level appeal to C2C Solutions and they responded with an unfavorable decision adn they stated that CPT 49904 is the primary code to use with 49905 and I really dont undertsnd that because 49904 states extra-abdominal and 49905 states intra-abdominal.
 
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