Wiki audit refund question

[Jamie Dezenzo]

First RAC audit
billed 28296 LT
28285 T1
28285 T2

Per WPS use 59 as last resort but requesting refund for both hammer toe codes. Anyone else have this issue?

Thanks!
Jamie

 

[GaPeach77]

Were the codes paid at 100% each? The modifier -51 should have been applied to the second code and third code in order for the multiple surgical reduction rate to be applied.

 

[Jamie Dezenzo]

No,
it was paid correctly 100/50/50 and Medicare added 51 modifer when processing.

 

[mitchellde]

First RAC audit
billed 28296 LT
28285 T1
28285 T2

Per WPS use 59 as last resort but requesting refund for both hammer toe codes. Anyone else have this issue?

Thanks!
Jamie

Jamie did they state a reason for requesting the refund? Perhaps the 28296 needed a TA(T5) instead of the LT that is what I would have used.

 

[Jamie Dezenzo]

Reason for Overpayment: The claim was submitted with incorrect information concerning the number of services or entry of charges. Therefore, payment was made to you in error.

 

[mitchellde]

Jamie, I would definitely appeal this take back as the reason for overpayment makes no sense at all. You need more information on exactly what the incorrect information is. I say stay on top of this and let us know what comes of it. I will watch this with interest!

 

[Jamie Dezenzo]

Yes, my thoughts exactly

 

[nsteinhauser]

Jamie, I suppose it's too early to ask if you've heard anything? Like Debra, I'm interested in this outcome, also. Thank you.

 

[Jamie Dezenzo]

nothing yet but did add 59 to hammer toe procedures.