Wiki Collateral Ligament

[nyyankees]

Is it acceptable to bill out a 29888, 29889 (posterior/anterior cruciate repair) along with 27405 (collateral repair). BC/BS is denying the 27405 as inclusive yet it's not in the CCI edits.

 

[Bella Cullen]

As long as doc had to make the incison bigger for the open procedure and/or it is a different part of the knee then I would appeal that.

 

[nyyankees]

Thanks. One of the problems that I'm having is getting the correct information as to what can go with what (I usually use the CCI edits) and what allows a procedure to be unbundled w/o sending up any red flags (aka 59 mod). Is there a website (other than AAPC) that will give me the correct coding information for denied surgeries.

I just want to make sure when a procedure is denied/bundled it is not the insurance company just trying to get out of paying multiple procedures.

Thanks

 

[Bella Cullen]

Thanks. One of the problems that I'm having is getting the correct information as to what can go with what (I usually use the CCI edits) and what allows a procedure to be unbundled w/o sending up any red flags (aka 59 mod). Is there a website (other than AAPC) that will give me the correct coding information for denied surgeries.

I just want to make sure when a procedure is denied/bundled it is not the insurance company just trying to get out of paying multiple procedures.

Thanks

Well what I found is that most of the people who work at the insurance companies are not coders and have no idea about the concept of coding so they will think it is inclusive to the primary procedure, but that is why it is our job as coders to appeal that and prove that it is indeed a separate procedure. I've had to appeal a bunch of cases, but everytime I win.
I use CCI also, but Cigna has their own on their website called Mckesson edits so I use that for Cigna patients, but other than those two I'm not sure of any other ones.

 

[nyyankees]

thanks