cliff.chen89
Contributor
Good Afternoon my fellow coders,
We are trying to get preauthorization for following arthroscopic knee surgical procedures:
Arthroscopic lysis of adhesion (29884) (separate procedure)
Arthroscopic MCL reconstruction
Arthroscopic or Open heterotopic ossification knee excision/debridement
From my understanding, arthroscopic MCL reconstruction has no specific CPT code and should be billed using 29999 with reference to 27427. And the closest I can find for heterotopic ossification knee excision/debridement is 27328, so depending on if it will be performed opened (27599) or arthroscopically (29999)
Firstly, are my code selections correct?
Second, what is the protocol for getting preauthorizations for unlisted CPT codes? I suspect the insurance may tell us that the unlisted codes don't need a preauth and won't give it to us. Then may later turn around and deny our claims for using unlisted codes. Should we try to get preauth for the codes that we are going to use as a reference for the unlisted codes? How does your office handle these types of situations?
Third, would you list 29999 twice if both the unlisted codes are being performed arthroscopically? would it be appropriate to append modifier 51/59/XU on one to help distinguish it on the claim form?
We are trying to get preauthorization for following arthroscopic knee surgical procedures:
Arthroscopic lysis of adhesion (29884) (separate procedure)
Arthroscopic MCL reconstruction
Arthroscopic or Open heterotopic ossification knee excision/debridement
From my understanding, arthroscopic MCL reconstruction has no specific CPT code and should be billed using 29999 with reference to 27427. And the closest I can find for heterotopic ossification knee excision/debridement is 27328, so depending on if it will be performed opened (27599) or arthroscopically (29999)
Firstly, are my code selections correct?
Second, what is the protocol for getting preauthorizations for unlisted CPT codes? I suspect the insurance may tell us that the unlisted codes don't need a preauth and won't give it to us. Then may later turn around and deny our claims for using unlisted codes. Should we try to get preauth for the codes that we are going to use as a reference for the unlisted codes? How does your office handle these types of situations?
Third, would you list 29999 twice if both the unlisted codes are being performed arthroscopically? would it be appropriate to append modifier 51/59/XU on one to help distinguish it on the claim form?