Wiki Lavh/bso and a&p repair

Create Wiki
W

wfriddle

Networker
Messages
43
Location
DALLAS CENTRAL
Best answers
0
Hello all,
I need some help. Back in October Medicare added an NCCI edit to make the A&P repair (57260) not payable (column two code) when billed with LAVH/BSO (58552). As if that wasn't weird enough it is not a column 2 code for an LAVH w/o BSO. How does that make any sense? Anyway, my doctor seems to think she read an article stating that this was corrected with Medicare to allow the A&P w/the LAVH but I can not find anything to support this. I found an article talking about adding modifiers to some of these codes under these new edits but this code in particular has "0" as the modifier status (never allowed). Does anyone know anything about this? Or have any advice on fighting Medicare on this? The edit makes no sense. HELP!!!!!
 
Not exactly

I did not find that exact article but it was an AUGS article. That one was actually more informative. The one I did find had an email address looking for responses to these issues. I emailed them and I got a response but it does not exactly answer the question so I have replied and I will respond here once I here back. Hopefully they can further explain this.
 
AUGS no help...

So after several emails back and forth with someone from AUGS I still don't have an answer. Their coding department keeps insisting that the A&P repair edits that bundle with LAVH and TVH should have been overturned but they are unable to produce any documentation stating as such for this particular code (58552). They are telling me to appeal with Medicare but I just don't see how I am going to have any luck with that when the only NCCI edit list I can find shows it as a column two code for the LAVH/BSO. I don't understand why they would have overturned it for the LAVH w/o BSO and not the one with BSO. This is so frustrating!! Does anyone have advice on fighting this with Medicare?
 
Surely we're not the only ones billing these procedures! Or is everyone else just writing it off? Definitely need back up when appealing to Medicare. The op notes aren't enough.
 
You must log in or register to reply here.
Top