Wiki Can 27334,59 be bill with 27488

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What research have you done before posting your question? Did you reach a decision? Do these codes hit an edit? If so, then the documentation would have to meet specific requirements to bill both codes. If the requirements are not met, then they would bundle. In all honesty at least 95% of all code pairs are allowed to be billed together. There are very few code pairings that don't allow both codes. So then question becomes, do the codes hit an edit? If so, do both codes qualify to be billed together? Or do they bundle? Again, what research have you done and what where your finding?
 
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I did do research, AAOS and Encoder Pro. They both state you can bill together with a modifier to over ride edit. The codes did hit a Medicare CCI edit. A modifier is allowed to over ride the unbundling. Which I did originally add 59 to 27334. Insurance still denied. I'm assuming the provider will have to produce a letter of medical necessity. See below findings...just need an expert opinion. Thanks in advance.


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So the codes hit an edit. In order for both codes to be supported, they would have to qualify for a -59 modifier. Does this op report show that both codes are supported and qualifies for a -59? In order to qualify for a -59 modifier there would need to be some "separation' between the procedures. Frequently in surgical coding the codes can qualify to be reported together when the procedures are performed through separate surgical incisions. Both of these procedures were performed through the same incision. Additionally per the coding instructions given by the AMA smaller surgical procedures are bundled with larger more extensive procedures when performed in the same area. There is no "separation" between these procedures, they bundle. They do not qualify for a -59 in this case.
 
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I would recommend obtaining if you don't have it, or consulting the AAOS Complete Global Service Data for Orthopedic Surgery. (Synovectomy is included)
In addition to reviewing the P2P edits, read the NCCI guidelines too. Just because you can add a 59 to bypass an edit doesn't mean it's correct, even if both of were documented (as you were advised above). The fact that the payer still denied it even with the 59 should also be a clue.
 
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