Wiki How would this be billed?

Create Wiki
cward267

cward267

Guest
Messages
17
Best answers
0
The codes below have been billed out - we have received payment but now ins is asking for $$ back - I have coded it out, (not as seen below) the way I know it is suppose to be billed.
Now I am getting feed back from another person that thinks it should be billed another way.

How would you code this?

28750 on the left foot
28285 T1
28585 T2
28285 T3
735.4 & 735.1

Thanks
 
Why are they asking for $$ back? We have had that problem lastly and it was due to paying incorrectly per the surgical fee schedule. Looks like our local bc went back several years and recouped due to that.

So without knowing why they are pulling back makes it hard to answer.

katie
 
With this carrier specifically, was the multiple surgical reduction applied when the claim was processed or did the procedures need a 51 modifier? Depending on the carrier, the surgical codes after the first one is needing a 51 modifier. If they paid full rate for all procedures then an overpayment was made.
 
ah...our local BC did the same thing and we have to return all the money as they showed us the policy change where they allow 100% for the 1st procedure and 50% for each procedure no matter what! So do not thing the modifier will help at all!

Sorry!

Katie Werner
 
It would help to know how you coded it on the claim and how the co worker feels it should be. It is hard to evaluate the correctness of a code(s) without benefit of the documentation
 
werner03 said:
ah...our local BC did the same thing and we have to return all the money as they showed us the policy change where they allow 100% for the 1st procedure and 50% for each procedure no matter what! So do not thing the modifier will help at all!

Sorry!

Katie Werner
Click to expand...

So why are they requesting money back from an overpayment if they applied the multiple surgery reduction rate? That is the reason why some surgery coding departments have a policy to add the 51 to commercial payers because of the fact that they will tell you there is no need to add the modifier and then low and behold, the procedures all pay at %100 and a request for a take back is mailed. Medicare and some state Medicaid payers are the only ones who I have personally seen apply the surgery reduction rate on ALL of their claims. The other payers are too wishy washy with it. CYA:rolleyes:
 
You must log in or register to reply here.
Top