03/08/2017

Correct Billing for CPT 28285 and 28297-HIP

The first line was paid at $638.55. they added a third line as 28285 and 5IT6/001 and the denial code that they gave that line was C47. Any help would be greatly appreciated. Just want to know if this was billed correctly. I only got paid for one procedure

According to the EOB from HIP, CPT 28285 was denied because even though it has a T modifier listed, it was inclusive to the payment for CPT 28297. If the op-reports support that these procedures were performed on different areas of the right foot, a corrected claim should be submitted with modifier 59 in addition, to the T6 modifier for CPT 28285.