Wiki Please help bundled code denial.

[bella2]

Hi,

I was wondering if anyone else is recieving denial for codes 23412 and 29826.
The carrier is Medicare, can we override the bundle with a 59 modifier.
The bundle dosen't make sense to me as one procedure is open and the other is arthroscopic ???

Thanks for any advice,

Bella

 

[LLovett]

Unless you are working on different sides the scope is going to be bundled into the open procedure.

Laura, CPC, CPMA, CEMC

 

[mitchellde]

Without the procedure note I cannot tell if a modifier is appropriate.

 

[mbort]

this is a tough one and probably will be for a long time.

You can override the edit but you need to make certain that the documentation supports the use of the 59 modifier.

If they did the decompression for visualization of the cuff tear= NO

Does the documentation support that the acomion was altered to a certain Type suggesting that there was bony work? Then probably