Forum - Questions & Answers

Apr 14th, 2016 - joans 1 

15374 description. Gastro surgery

Hi All,
WE have been encountering a problem in finding the correct CPT® for "component separation" Is the 15734 the correct CPT® or is there another code that better describes the procedure? The surgeon also wants to report this bilaterally which does not apply to this code so may be we're in the wrong direction .
Thank you in advance for any help
Kind regards,
JP

Apr 15th, 2016 - sesagarra    2 

re: 15374 description. Gastro surgery

We are having the same issue on our Ventral Hernia Repairs/Component Separation - especially with UHC. They are denying indicating that the operative notes do not indicate a valid diagnosis such as "muscle weakness" to validate the service.
As for bilateral, we have been told by our CBO that we cannot bill bilaterally, but to try using -RT & -LT modifiers, at least with payers who follow Medicare.
Sharon



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