bmasser
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ADVICE NEEDED! Was this coded correctly?
ADVICE NEEDED!
Attaching OR note for claim where the Provider billed:
23412: repair of ruptured musculotendinous cuff (rotator cuff) open; chronic
23131-59-51: acromioplasty or acromionectomy, partial, with or without coracoacromial ligament release.
There is a NCCI edit on the 23131, which allows for the mod 59 to over-ride and pay.
Does the documentation support reporting 23420 instead of the code pair above?
I'm trying to determine if the records support "reconstruction" of the cuff or not.
I agree that 2 procedures need to be reimbursed, but there is about a 6 RVU advantage to the provider for billing the code pair (23412 and 23131) versus the single code (23420).
Thanks coders!
Bonnie
ADVICE NEEDED!
Attaching OR note for claim where the Provider billed:
23412: repair of ruptured musculotendinous cuff (rotator cuff) open; chronic
23131-59-51: acromioplasty or acromionectomy, partial, with or without coracoacromial ligament release.
There is a NCCI edit on the 23131, which allows for the mod 59 to over-ride and pay.
Does the documentation support reporting 23420 instead of the code pair above?
I'm trying to determine if the records support "reconstruction" of the cuff or not.
I agree that 2 procedures need to be reimbursed, but there is about a 6 RVU advantage to the provider for billing the code pair (23412 and 23131) versus the single code (23420).
Thanks coders!
Bonnie
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