Wiki Need help with surgery

[TCARBINO]

I BILLED 28119 WITH LT MODIFIER
THEN 64704 WITH A 51 IT DENIED SAYING IT WAS INCLUSIVE TO THE 28119

THEN ON ANOTHER SURGERY I BILLED 28296 WITH LT MODIFIER THEN 28285 51 LT IT DENIED SAYING IT WAS INCLUSIVE
DOES ANYONE KNOW WHY SHOULD I HAVE THE 59 MODIFIER INSTEAD.
THANKS

 

[cgallimore]

For CPT 28296 & 28285 - CPT 28285 is bundled into 28296 per CCI so you would need a 59 to unbundle it. You should also use the digit modifier for 28285 instead of LT.

For CPT 28119 & 64704 - this could be a carrier 'black box' type edit. Some payers have their own edits in place. You should be able to appeal the decision with your documentation.

 

[TCARBINO]

Thank you

I just wanted to say thank you