Wiki Billing normal bundled procedures on separate anatomical site

[Christine713]

I have a question regarding normally bundled procedures. I work in an orthopedic surgeon's office and we are running into problems with one of our payors who states that normally bundled procedures cannot ever be billed separately, even if they are on opposite knees. We are aware of Medicare exceptions but are unable to locate the information to support billing each knee separately. All of our other payers pay on each knee in this instance after an appeal.

example:
29881 RT (partial medial menisectomy)
29877 LT (Debridement)

I understand when these procedures are performed on the same knee they are bundled(we would use G0289 for the debridement) however these are opposite limbs and therefore the G code does not apply. We have tried the XS modifier as well as RT and LT modifiers without success. Any help would be appreciated.

Thank you
Christine

 

[amyjph]

You are correct when they are performed on opposite sides they should both be paid. I would append a 59 to the 29877 and make a note in the narrative field of the claim. You will probably have to ask for a claim reconsideration or appeal it if denied but with a letter explaining and the op note showing it was not done on the same knee it needs to be paid. It's crazy when you are clearly showing it was RT/LT. This happens to us a lot but they always get paid with some further pushing on our part. They are wrong. I would even take it further up the line from the person telling you this.