Forum - Questions & Answers

Feb 2nd, 2016 - jackson2012 5 

29280 : reg

We have billed 29280 with E/M 25 and getting denial as not pay separately. we have used Dx 883.1 for DOS 09/04/2015. This is CA W/C. Can any one please guide me whether we can use any modifier on this?,

thank you

Feb 2nd, 2016 - codinqueen 57 

re: 29280 : reg

Worker's comp is very particular in ANY state & they probably will deny it for no precert anyway, if you didn't precert it, no matter how you code it. If you add any modifiers, add the modifier for the finger and see what happens. Did you get a denial on the EOB? It might be a moot point since usual and customary services for a finger wound would include a dressing of some kind which is included in the E/M code, & I cant imagine why strapping would be medically necessary in this case, but perhaps you didn't post all the info. You could appeal it if they deny it, but appeals don't usually get the original determination on the claim overturned, for WC claims. Depends how much time your office wants to spend on trying to get paid for a strapping, which probably doesn't carry a very high RVU anyway. I don't have access to RVUs because I code outpatient surgery claims for a facility. 29280 is a Level II Minor procedure code and gives APC 00340, and I am not sure if the revenue code is 50X or something else since I don't code any of these. I wish you luck!

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