PJZ ASC Coder
New
The surgeon performed tenolysis of 4 flexor tendons in the patient's right hand and we billed UHC 26440 x 4. CMS states that the MUE for 26440 is 6 units. However, UHC is stating that they do not allow more than 3 units. Our biller asked the insurance rep if we could add mod 59 to the 4th unit and send in a corrected claim. The rep stated yes we could and it would be paid. My question is, how is mod 59 appropriate if the 4th tenolysis was performed in the same hand and through the same incision as the other 3? Is it appropriate because they are 4 separate flexor tendons and the code states "each tendon"? Please help?