Wiki Shoulder Arthroscopy

[blnord]

I'm trying to help a nurse practitioner that assists an orthopedic surgeon with some billing and I'm kind of new to this specialty so if anyone could help?
She billed the following DX codes 726.19, 715.11 and 840.4 with the following (all had 80 modifier)
23412
23430
29823 59
29826 59
29824
37202
Medicare has denied saying the diagnosis code is inconsistent with the procedure? Any help, input and/or advice would be appreciated.
Thank you,

 

[nyyankees]

I'm trying to help a nurse practitioner that assists an orthopedic surgeon with some billing and I'm kind of new to this specialty so if anyone could help?
She billed the following DX codes 726.19, 715.11 and 840.4 with the following (all had 80 modifier)
23412
23430
29823 59
29826 59
29824
37202
Medicare has denied saying the diagnosis code is inconsistent with the procedure? Any help, input and/or advice would be appreciated.
Thank you,

you are missing the dx codes for 23430 (biceps tear? 727.62?) and a dx for 29823 (what was debrided outside of cuff, biceps and clavivle?). Not sure what 37202 is for. Plus double check to see that Medicare allows for an Assist on these codes. If it's an NPP you should use the AS modifier.

 

[mitchellde]

An op note would be more helpful but the dx codes do look a little inconsistent what was the reason for the surgery?

 

[blnord]

Thank you, I know she is getting the codes and DX from the surgeons biller so is duplicating what he billed, 37202 is TCAT? Im going to request the op report today, I know this will help.
Thank you!!!

 

[blnord]

An op note would be more helpful but the dx codes do look a little inconsistent what was the reason for the surgery?

I have the op report now, is there anything specific that I should be looking for to know what's going on? I really appreciate all help as I'm at a loss...........