Forum - Questions & Answers

Apr 3rd, 2012 - lockmand 3 

13101 & 13102

I received a denial from Great West and was wondering if some one could help me? the provider billed the following codes 49565, 49568, 13101 13102 and 49320. Per CCI and NCCI there are not coding conflicts- however per Mckesson edits 13101 and 13102 bothe bundle with 49568, which can be overridden with modifier 59. I was told it would be okay to add modifier 59 due to this closure was not the normal closure as the patient had a previous surgery and had very little skin to work with. Can I bill 13101 and 13102 with modifier 59 appended. I'm getting conflicitin informaiton... Can someone please help me with this.
-My understanding per the General surgery guidelines states that surgical closure is included for all open procedures other than those in the integ. System, and if the doctor made the incision to repair the hernia, the closure would be included...



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