Wiki Denial for CPT 27134 Help

[debellis59]

In December I coded CPT 27134 for the surgeon and the assist. According to Noridian Medicare, this is covered for the assist. So, now I've received two denials saying the surgeon's claim is bumping up against the assistant's claim ... which they actually paid, and therefore is denied. I don't do the billing, that's a different department (sometimes unfortunately), and I'm at a loss what to do. Any suggestions?

 

[amyjph]

Usually it means the modifier was wrong or forgotten. If the assistant claim went through but didn't have the AS or 80 (depending on who assisted) it probably got paid at the primary surgeon rate. Now they are seeing a second claim with no modifier for the same exact thing. The first step is checking the modifiers and the fee that was billed on each. The assistant one should not be the exact same fee.
It's usually the easiest and most obvious reason when it comes to denials. Start with the basics and go from there.