Wiki I&D with Partial excision of 1st Metatarsal

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VoitChromy

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Can someone please give me their opinion on this op report. It was billed as 28122 and 28003. 28003 was denied and the doctor is insisting it should be payable, but I know they are bundled codes and can not find reason to show him why they are inclusive codes.
 

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As documented I don't see 28122 as this seems to be more of a biopsy rather than removing bone treating pathology. For this documentation, I would only bill out 28003 as the other was a biopsy. Since these codes hit an edit, there would have to be "separation" of some kind in order for both to qualify for billing. Since these were performed through the same surgical incision, there is no separation and only one code could be submitted. If these procedures were performed through separate incisions the documentation does not make that clear. Two cents.
 
Additional thoughts. I gave this a good reading and have a few pointers. The post-op diagnosis is "possible" osteomyelitis. There is no code for that. After performing the I&D procedure the surgeon opened the MTP joint capsule to see if there was any infection and found none. Then the doc took a bone biopsy and did remove some bone. You can go back to the pathology report and see if there were any abnormalities in that bone. But what I said before still stands. Even if pathology was found in the bone, it still hits an edit. Since these two procedures were performed through the same surgical opening, only one code can be submitted. Your doc needs to understand that every cpt submitted needs to be linked to an ICD.10 that supports the code. "Possible" osteomyelitis does not support the procedure.
 
Thank you for your response. The office just pushed charges and now the biller is asking my opinion on how to get it paid and help with appeal. I suggested to her that they need to show the doctor the description of each procedure so he can see how they would be bundled. And maybe give him Some tips on better documentation of what he does.
 
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